|
PR CLSR NEPHROVISCERAL FISTULA W/VISC RPR THRC APPR
|
Professional
|
Both
|
$7,132.48
|
|
|
Service Code
|
HCPCS 50526
|
| Min. Negotiated Rate |
$1,319.58 |
| Max. Negotiated Rate |
$4,241.52 |
| Rate for Payer: Cash Price |
$1,898.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,885.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,696.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,696.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,790.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,885.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,790.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,885.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,885.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,413.84
|
| Rate for Payer: Healthfirst Commercial |
$1,885.12
|
| Rate for Payer: Healthfirst Essential Plan |
$4,241.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,790.86
|
| Rate for Payer: Healthfirst QHP |
$1,885.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,319.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,885.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,602.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,319.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,885.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,413.84
|
| Rate for Payer: SOMOS Essential |
$1,413.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,885.12
|
|
|
PR CLSR NTRSTM LG/SM RESCJ & ANAST OTH/THN CLRCT
|
Professional
|
Both
|
$4,438.63
|
|
|
Service Code
|
HCPCS 44625
|
| Min. Negotiated Rate |
$825.09 |
| Max. Negotiated Rate |
$2,652.07 |
| Rate for Payer: Cash Price |
$1,190.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,178.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,060.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,060.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,119.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,178.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,119.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,178.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,178.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$884.02
|
| Rate for Payer: Healthfirst Commercial |
$1,178.70
|
| Rate for Payer: Healthfirst Essential Plan |
$2,652.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,119.77
|
| Rate for Payer: Healthfirst QHP |
$1,178.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$825.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,178.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,001.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$825.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,178.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$884.02
|
| Rate for Payer: SOMOS Essential |
$884.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,178.70
|
|
|
PR CLSR NTRSTM LG/SM RESCJ & COLORECTAL ANASTOMOSIS
|
Professional
|
Both
|
$7,077.95
|
|
|
Service Code
|
HCPCS 44626
|
| Min. Negotiated Rate |
$1,305.88 |
| Max. Negotiated Rate |
$4,197.47 |
| Rate for Payer: Cash Price |
$1,883.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,865.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,678.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,678.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,772.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,865.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,772.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,865.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,865.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,399.15
|
| Rate for Payer: Healthfirst Commercial |
$1,865.54
|
| Rate for Payer: Healthfirst Essential Plan |
$4,197.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,772.26
|
| Rate for Payer: Healthfirst QHP |
$1,865.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,305.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,865.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,585.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,305.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,865.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,399.15
|
| Rate for Payer: SOMOS Essential |
$1,399.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,865.54
|
|
|
PR CLSR RECTOVAG FSTL ABDL APPR W/CONCOMITANT CLST
|
Professional
|
Both
|
$4,634.46
|
|
|
Service Code
|
HCPCS 57307
|
| Min. Negotiated Rate |
$866.68 |
| Max. Negotiated Rate |
$2,785.75 |
| Rate for Payer: Cash Price |
$1,253.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,238.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,114.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,114.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,176.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,238.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,176.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,238.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,238.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$928.58
|
| Rate for Payer: Healthfirst Commercial |
$1,238.11
|
| Rate for Payer: Healthfirst Essential Plan |
$2,785.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,176.20
|
| Rate for Payer: Healthfirst QHP |
$1,238.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$866.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,238.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,052.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$866.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,238.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$928.58
|
| Rate for Payer: SOMOS Essential |
$928.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,238.11
|
|
|
PR CLSR RECTOVAG FSTL TPRNL PRNL BDY RCNSTJ
|
Professional
|
Both
|
$2,839.45
|
|
|
Service Code
|
HCPCS 57308
|
| Min. Negotiated Rate |
$535.98 |
| Max. Negotiated Rate |
$1,722.78 |
| Rate for Payer: Cash Price |
$773.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$765.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$689.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$689.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$727.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$765.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$727.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$765.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$765.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$574.26
|
| Rate for Payer: Healthfirst Commercial |
$765.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,722.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$727.40
|
| Rate for Payer: Healthfirst QHP |
$765.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$535.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$765.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$650.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$535.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$765.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$574.26
|
| Rate for Payer: SOMOS Essential |
$574.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$765.68
|
|
|
PR CLSR RECTOVAGINAL FISTULA ABDOMINAL APPROACH
|
Professional
|
Both
|
$4,339.13
|
|
|
Service Code
|
HCPCS 57305
|
| Min. Negotiated Rate |
$794.32 |
| Max. Negotiated Rate |
$2,553.16 |
| Rate for Payer: Cash Price |
$1,157.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,134.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,021.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,021.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,078.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,134.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,078.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,134.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,134.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$851.05
|
| Rate for Payer: Healthfirst Commercial |
$1,134.74
|
| Rate for Payer: Healthfirst Essential Plan |
$2,553.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,078.00
|
| Rate for Payer: Healthfirst QHP |
$1,134.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$794.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,134.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$964.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$794.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,134.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$851.05
|
| Rate for Payer: SOMOS Essential |
$851.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,134.74
|
|
|
PR CLSR RECTOVAGINAL FISTULA VAGINAL/TRANSANAL APPR
|
Professional
|
Both
|
$2,674.60
|
|
|
Service Code
|
HCPCS 57300
|
| Min. Negotiated Rate |
$499.58 |
| Max. Negotiated Rate |
$1,605.80 |
| Rate for Payer: Cash Price |
$725.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$713.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$642.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$642.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$678.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$713.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$678.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$713.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$713.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$535.27
|
| Rate for Payer: Healthfirst Commercial |
$713.69
|
| Rate for Payer: Healthfirst Essential Plan |
$1,605.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$678.01
|
| Rate for Payer: Healthfirst QHP |
$713.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$499.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$713.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$606.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$499.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$713.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$535.27
|
| Rate for Payer: SOMOS Essential |
$535.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$713.69
|
|
|
PR CLSR RECTOVESICAL FISTULA W/COLOSTOMY
|
Professional
|
Both
|
$6,634.57
|
|
|
Service Code
|
HCPCS 45805
|
| Min. Negotiated Rate |
$1,226.39 |
| Max. Negotiated Rate |
$3,941.98 |
| Rate for Payer: Cash Price |
$1,766.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,751.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,576.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,576.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,664.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,751.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,664.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,751.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,751.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,313.99
|
| Rate for Payer: Healthfirst Commercial |
$1,751.99
|
| Rate for Payer: Healthfirst Essential Plan |
$3,941.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,664.39
|
| Rate for Payer: Healthfirst QHP |
$1,751.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,226.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,751.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,489.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,226.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,751.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,313.99
|
| Rate for Payer: SOMOS Essential |
$1,313.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,751.99
|
|
|
PR CLSR URETHROSTOMY/URETHROQ FSTL MALE SPX
|
Professional
|
Both
|
$2,348.96
|
|
|
Service Code
|
HCPCS 53520
|
| Min. Negotiated Rate |
$448.45 |
| Max. Negotiated Rate |
$1,441.46 |
| Rate for Payer: Cash Price |
$645.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$640.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$576.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$576.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$608.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$640.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$608.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$640.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$640.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$480.49
|
| Rate for Payer: Healthfirst Commercial |
$640.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,441.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$608.62
|
| Rate for Payer: Healthfirst QHP |
$640.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$448.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$640.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$544.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$448.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$640.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$480.49
|
| Rate for Payer: SOMOS Essential |
$480.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$640.65
|
|
|
PR CLSR URETHROVAG FSTL W/BULBOCAVERNOSUS TRNSPL
|
Professional
|
Both
|
$2,350.43
|
|
|
Service Code
|
HCPCS 57311
|
| Min. Negotiated Rate |
$445.92 |
| Max. Negotiated Rate |
$1,433.32 |
| Rate for Payer: Cash Price |
$644.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$573.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$573.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$605.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$605.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$637.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$477.77
|
| Rate for Payer: Healthfirst Commercial |
$637.03
|
| Rate for Payer: Healthfirst Essential Plan |
$1,433.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$605.18
|
| Rate for Payer: Healthfirst QHP |
$637.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$445.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$637.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$541.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$445.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$477.77
|
| Rate for Payer: SOMOS Essential |
$477.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.03
|
|
|
PR CLSR VESICOUTERINE FISTULA W/HYSTERECTOMY
|
Professional
|
Both
|
$4,698.54
|
|
|
Service Code
|
HCPCS 51925
|
| Min. Negotiated Rate |
$871.64 |
| Max. Negotiated Rate |
$2,801.70 |
| Rate for Payer: Cash Price |
$1,265.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,245.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,120.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,120.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,182.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,245.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,182.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,245.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,245.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$933.90
|
| Rate for Payer: Healthfirst Commercial |
$1,245.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,801.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,182.94
|
| Rate for Payer: Healthfirst QHP |
$1,245.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$871.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,245.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,058.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$871.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,245.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$933.90
|
| Rate for Payer: SOMOS Essential |
$933.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,245.20
|
|
|
PR CLSR VESICOVAG FSTL TRANSVESICAL&VAG APPR
|
Professional
|
Both
|
$3,229.94
|
|
|
Service Code
|
HCPCS 57330
|
| Min. Negotiated Rate |
$612.60 |
| Max. Negotiated Rate |
$1,969.07 |
| Rate for Payer: Cash Price |
$883.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$875.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$787.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$787.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$831.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$875.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$831.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$875.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$875.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$656.36
|
| Rate for Payer: Healthfirst Commercial |
$875.14
|
| Rate for Payer: Healthfirst Essential Plan |
$1,969.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$831.38
|
| Rate for Payer: Healthfirst QHP |
$875.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$612.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$875.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$743.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$612.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$875.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$656.36
|
| Rate for Payer: SOMOS Essential |
$656.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$875.14
|
|
|
PR CLSR VESICOVAGINAL FISTUL AABDL APPROACH
|
Professional
|
Both
|
$3,449.85
|
|
|
Service Code
|
HCPCS 51900
|
| Min. Negotiated Rate |
$657.78 |
| Max. Negotiated Rate |
$2,114.28 |
| Rate for Payer: Cash Price |
$943.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$939.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$845.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$845.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$892.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$939.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$892.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$939.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$939.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$704.76
|
| Rate for Payer: Healthfirst Commercial |
$939.68
|
| Rate for Payer: Healthfirst Essential Plan |
$2,114.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$892.70
|
| Rate for Payer: Healthfirst QHP |
$939.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$657.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$939.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$798.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$657.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$939.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$704.76
|
| Rate for Payer: SOMOS Essential |
$704.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$939.68
|
|
|
PR CLSR V-SEPTAL DFCT W/RMVL P-ART BAND W/WO GUSSET
|
Professional
|
Both
|
$8,372.00
|
|
|
Service Code
|
HCPCS 33688
|
| Min. Negotiated Rate |
$1,536.55 |
| Max. Negotiated Rate |
$4,938.91 |
| Rate for Payer: Cash Price |
$2,220.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,195.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,975.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,975.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,085.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,195.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,085.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,195.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,195.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,646.30
|
| Rate for Payer: Healthfirst Commercial |
$2,195.07
|
| Rate for Payer: Healthfirst Essential Plan |
$4,938.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,085.32
|
| Rate for Payer: Healthfirst QHP |
$2,195.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,536.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,195.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,865.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,536.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,195.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,646.30
|
| Rate for Payer: SOMOS Essential |
$1,646.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,195.07
|
|
|
PR CLSR V-SEPTL DFCT W/PULM VLVT/INFUND RESCJ
|
Professional
|
Both
|
$8,398.85
|
|
|
Service Code
|
HCPCS 33684
|
| Min. Negotiated Rate |
$1,544.14 |
| Max. Negotiated Rate |
$4,963.32 |
| Rate for Payer: Cash Price |
$2,229.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,205.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,985.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,985.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,095.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,205.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,095.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,205.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,205.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,654.44
|
| Rate for Payer: Healthfirst Commercial |
$2,205.92
|
| Rate for Payer: Healthfirst Essential Plan |
$4,963.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,095.62
|
| Rate for Payer: Healthfirst QHP |
$2,205.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,544.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,205.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,875.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,544.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,205.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,654.44
|
| Rate for Payer: SOMOS Essential |
$1,654.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,205.92
|
|
|
PR CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT 1ST 25CM/<
|
Professional
|
Both
|
$3,185.11
|
|
|
Service Code
|
HCPCS 15155
|
| Min. Negotiated Rate |
$599.75 |
| Max. Negotiated Rate |
$1,927.78 |
| Rate for Payer: Cash Price |
$857.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$856.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$771.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$771.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$813.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$856.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$813.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$856.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$856.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$642.59
|
| Rate for Payer: Healthfirst Commercial |
$856.79
|
| Rate for Payer: Healthfirst Essential Plan |
$1,927.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$813.95
|
| Rate for Payer: Healthfirst QHP |
$856.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$599.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$856.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$728.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$599.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$856.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$642.59
|
| Rate for Payer: SOMOS Essential |
$642.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$856.79
|
|
|
PR CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT ADDL 1-75CM
|
Professional
|
Both
|
$678.41
|
|
|
Service Code
|
HCPCS 15156
|
| Min. Negotiated Rate |
$125.29 |
| Max. Negotiated Rate |
$402.73 |
| Rate for Payer: Cash Price |
$180.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$178.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$161.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$178.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.24
|
| Rate for Payer: Healthfirst Commercial |
$178.99
|
| Rate for Payer: Healthfirst Essential Plan |
$402.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$170.04
|
| Rate for Payer: Healthfirst QHP |
$178.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$125.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$178.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$152.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$125.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$178.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$134.24
|
| Rate for Payer: SOMOS Essential |
$134.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$178.99
|
|
|
PR CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT EA 100 EA
|
Professional
|
Both
|
$740.53
|
|
|
Service Code
|
HCPCS 15157
|
| Min. Negotiated Rate |
$136.37 |
| Max. Negotiated Rate |
$438.32 |
| Rate for Payer: Cash Price |
$196.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$194.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$175.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$194.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.11
|
| Rate for Payer: Healthfirst Commercial |
$194.81
|
| Rate for Payer: Healthfirst Essential Plan |
$438.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.07
|
| Rate for Payer: Healthfirst QHP |
$194.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$194.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$165.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$194.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.11
|
| Rate for Payer: SOMOS Essential |
$146.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$194.81
|
|
|
PR CLTR SKIN AGRFT T/A/L ADDL 1 CM-75 CM
|
Professional
|
Both
|
$496.41
|
|
|
Service Code
|
HCPCS 15151
|
| Min. Negotiated Rate |
$90.68 |
| Max. Negotiated Rate |
$291.46 |
| Rate for Payer: Cash Price |
$130.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.16
|
| Rate for Payer: Healthfirst Commercial |
$129.54
|
| Rate for Payer: Healthfirst Essential Plan |
$291.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$123.06
|
| Rate for Payer: Healthfirst QHP |
$129.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$129.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.16
|
| Rate for Payer: SOMOS Essential |
$97.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.54
|
|
|
PR CLTR SKIN AGRFT T/A/L EA 100 CM/EA 1%BODY AREA
|
Professional
|
Both
|
$622.30
|
|
|
Service Code
|
HCPCS 15152
|
| Min. Negotiated Rate |
$118.38 |
| Max. Negotiated Rate |
$380.50 |
| Rate for Payer: Cash Price |
$163.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$169.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$152.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$169.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.83
|
| Rate for Payer: Healthfirst Commercial |
$169.11
|
| Rate for Payer: Healthfirst Essential Plan |
$380.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$160.65
|
| Rate for Payer: Healthfirst QHP |
$169.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$118.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$169.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$143.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$118.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$169.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.83
|
| Rate for Payer: SOMOS Essential |
$126.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.11
|
|
|
PR CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/<
|
Professional
|
Both
|
$2,882.71
|
|
|
Service Code
|
HCPCS 15150
|
| Min. Negotiated Rate |
$536.07 |
| Max. Negotiated Rate |
$1,723.10 |
| Rate for Payer: Cash Price |
$770.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$765.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$689.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$689.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$727.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$765.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$727.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$765.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$765.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$574.37
|
| Rate for Payer: Healthfirst Commercial |
$765.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,723.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$727.53
|
| Rate for Payer: Healthfirst QHP |
$765.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$536.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$765.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$650.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$536.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$765.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$574.37
|
| Rate for Payer: SOMOS Essential |
$574.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$765.82
|
|
|
PR CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$4,366.78
|
|
|
Service Code
|
HCPCS 27222
|
| Min. Negotiated Rate |
$815.44 |
| Max. Negotiated Rate |
$2,621.05 |
| Rate for Payer: Cash Price |
$1,169.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,164.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,048.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,048.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,106.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,164.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,106.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,164.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,164.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$873.68
|
| Rate for Payer: Healthfirst Commercial |
$1,164.91
|
| Rate for Payer: Healthfirst Essential Plan |
$2,621.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,106.66
|
| Rate for Payer: Healthfirst QHP |
$1,164.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$815.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,164.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$990.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$815.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,164.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$873.68
|
| Rate for Payer: SOMOS Essential |
$873.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,164.91
|
|
|
PR CLTX ACETABULUM HIP/SOCKT FX W/O MANJ
|
Professional
|
Both
|
$1,839.25
|
|
|
Service Code
|
HCPCS 27220
|
| Min. Negotiated Rate |
$347.11 |
| Max. Negotiated Rate |
$1,115.71 |
| Rate for Payer: Cash Price |
$498.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$495.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$446.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$446.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$471.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$495.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$471.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$495.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$495.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$371.90
|
| Rate for Payer: Healthfirst Commercial |
$495.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,115.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$471.08
|
| Rate for Payer: Healthfirst QHP |
$495.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$347.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$495.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$421.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$347.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$495.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$371.90
|
| Rate for Payer: SOMOS Essential |
$371.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$495.87
|
|
|
PR CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ
|
Professional
|
Both
|
$2,176.76
|
|
|
Service Code
|
HCPCS 27842
|
| Min. Negotiated Rate |
$414.19 |
| Max. Negotiated Rate |
$1,331.33 |
| Rate for Payer: Cash Price |
$594.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$591.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$532.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$532.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$562.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$591.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$562.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$591.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$591.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$443.77
|
| Rate for Payer: Healthfirst Commercial |
$591.70
|
| Rate for Payer: Healthfirst Essential Plan |
$1,331.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$562.12
|
| Rate for Payer: Healthfirst QHP |
$591.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$414.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$591.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$502.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$414.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$591.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$443.77
|
| Rate for Payer: SOMOS Essential |
$443.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$591.70
|
|
|
PR CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ
|
Professional
|
Both
|
$1,511.13
|
|
|
Service Code
|
HCPCS 26742
|
| Min. Negotiated Rate |
$286.69 |
| Max. Negotiated Rate |
$921.51 |
| Rate for Payer: Cash Price |
$410.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$409.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$368.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$368.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$389.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$389.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$409.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.17
|
| Rate for Payer: Healthfirst Commercial |
$409.56
|
| Rate for Payer: Healthfirst Essential Plan |
$921.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$389.08
|
| Rate for Payer: Healthfirst QHP |
$409.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$286.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$409.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$348.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$286.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$409.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.17
|
| Rate for Payer: SOMOS Essential |
$307.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$409.56
|
|
