|
PR DRAINAGE OF RETROPERITONEAL ABSCESS OPEN
|
Professional
|
Both
|
$4,877.71
|
|
|
Service Code
|
HCPCS 49060
|
| Min. Negotiated Rate |
$915.45 |
| Max. Negotiated Rate |
$2,942.51 |
| Rate for Payer: Cash Price |
$1,304.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,307.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,177.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,177.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,242.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,307.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,242.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,307.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,307.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$980.84
|
| Rate for Payer: Healthfirst Commercial |
$1,307.78
|
| Rate for Payer: Healthfirst Essential Plan |
$2,942.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,242.39
|
| Rate for Payer: Healthfirst QHP |
$1,307.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$915.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,307.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,111.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$915.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,307.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$980.84
|
| Rate for Payer: SOMOS Essential |
$980.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,307.78
|
|
|
PR DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH
|
Professional
|
Both
|
$3,122.63
|
|
|
Service Code
|
HCPCS 58822
|
| Min. Negotiated Rate |
$580.50 |
| Max. Negotiated Rate |
$1,865.88 |
| Rate for Payer: Cash Price |
$842.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$829.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$746.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$746.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$787.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$829.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$787.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$829.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$829.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$621.96
|
| Rate for Payer: Healthfirst Commercial |
$829.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,865.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$787.82
|
| Rate for Payer: Healthfirst QHP |
$829.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$580.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$829.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$704.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$580.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$829.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$621.96
|
| Rate for Payer: SOMOS Essential |
$621.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$829.28
|
|
|
PR DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN
|
Professional
|
Both
|
$1,486.35
|
|
|
Service Code
|
HCPCS 58820
|
| Min. Negotiated Rate |
$277.02 |
| Max. Negotiated Rate |
$890.41 |
| Rate for Payer: Cash Price |
$401.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$395.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$356.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$356.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$375.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$395.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$375.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$395.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$296.81
|
| Rate for Payer: Healthfirst Commercial |
$395.74
|
| Rate for Payer: Healthfirst Essential Plan |
$890.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$375.95
|
| Rate for Payer: Healthfirst QHP |
$395.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$277.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$395.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$336.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$277.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$395.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$296.81
|
| Rate for Payer: SOMOS Essential |
$296.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$395.74
|
|
|
PR DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL
|
Professional
|
Both
|
$1,874.67
|
|
|
Service Code
|
HCPCS 58805
|
| Min. Negotiated Rate |
$348.11 |
| Max. Negotiated Rate |
$1,118.92 |
| Rate for Payer: Cash Price |
$507.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$497.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$447.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$447.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$472.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$497.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$472.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$497.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$497.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$372.98
|
| Rate for Payer: Healthfirst Commercial |
$497.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,118.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$472.44
|
| Rate for Payer: Healthfirst QHP |
$497.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$348.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$497.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$422.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$348.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$497.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$372.98
|
| Rate for Payer: SOMOS Essential |
$372.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$497.30
|
|
|
PR DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR
|
Professional
|
Both
|
$1,378.97
|
|
|
Service Code
|
HCPCS 58800
|
| Min. Negotiated Rate |
$258.35 |
| Max. Negotiated Rate |
$830.41 |
| Rate for Payer: Cash Price |
$373.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$369.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$332.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$332.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$350.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$369.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$350.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$369.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$369.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$276.80
|
| Rate for Payer: Healthfirst Commercial |
$369.07
|
| Rate for Payer: Healthfirst Essential Plan |
$830.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$350.62
|
| Rate for Payer: Healthfirst QHP |
$369.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$258.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$369.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$313.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$258.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$369.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$276.80
|
| Rate for Payer: SOMOS Essential |
$276.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$369.07
|
|
|
PR DRAINAGE PERIRENAL/RENAL ABSCESS OPEN
|
Professional
|
Both
|
$4,244.24
|
|
|
Service Code
|
HCPCS 50020
|
| Min. Negotiated Rate |
$807.57 |
| Max. Negotiated Rate |
$2,595.76 |
| Rate for Payer: Cash Price |
$1,161.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,153.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,038.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,038.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,095.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,153.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,095.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,153.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,153.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$865.25
|
| Rate for Payer: Healthfirst Commercial |
$1,153.67
|
| Rate for Payer: Healthfirst Essential Plan |
$2,595.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,095.99
|
| Rate for Payer: Healthfirst QHP |
$1,153.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$807.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,153.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$980.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$807.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,153.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$865.25
|
| Rate for Payer: SOMOS Essential |
$865.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,153.67
|
|
|
PR DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN
|
Professional
|
Both
|
$7,124.01
|
|
|
Service Code
|
HCPCS 49020
|
| Min. Negotiated Rate |
$1,322.77 |
| Max. Negotiated Rate |
$4,251.76 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,889.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,700.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,700.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,795.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,889.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,795.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,889.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,889.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,417.25
|
| Rate for Payer: Healthfirst Commercial |
$1,889.67
|
| Rate for Payer: Healthfirst Essential Plan |
$4,251.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,795.19
|
| Rate for Payer: Healthfirst QHP |
$1,889.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,322.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,889.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,606.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,322.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,889.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,417.25
|
| Rate for Payer: SOMOS Essential |
$1,417.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,889.67
|
|
|
PR DRAINAGE SCROTAL WALL ABSCESS
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 55100
|
| Min. Negotiated Rate |
$137.15 |
| Max. Negotiated Rate |
$440.84 |
| Rate for Payer: Cash Price |
$196.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$195.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$176.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$195.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.95
|
| Rate for Payer: Healthfirst Commercial |
$195.93
|
| Rate for Payer: Healthfirst Essential Plan |
$440.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$186.13
|
| Rate for Payer: Healthfirst QHP |
$195.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$137.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$195.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$137.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$195.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.95
|
| Rate for Payer: SOMOS Essential |
$146.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.93
|
|
|
PR DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN
|
Professional
|
Both
|
$4,497.61
|
|
|
Service Code
|
HCPCS 49040
|
| Min. Negotiated Rate |
$837.63 |
| Max. Negotiated Rate |
$2,692.39 |
| Rate for Payer: Cash Price |
$1,202.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,196.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,076.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,076.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,136.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,196.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,136.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,196.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,196.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$897.47
|
| Rate for Payer: Healthfirst Commercial |
$1,196.62
|
| Rate for Payer: Healthfirst Essential Plan |
$2,692.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,136.79
|
| Rate for Payer: Healthfirst QHP |
$1,196.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$837.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,196.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,017.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$837.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,196.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$897.47
|
| Rate for Payer: SOMOS Essential |
$897.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,196.62
|
|
|
PR DRAINAGE TENDON SHEATH DIGIT&/PALM EACH
|
Professional
|
Both
|
$2,461.87
|
|
|
Service Code
|
HCPCS 26020
|
| Min. Negotiated Rate |
$467.09 |
| Max. Negotiated Rate |
$1,501.36 |
| Rate for Payer: Cash Price |
$668.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$667.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$600.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$600.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$633.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$667.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$633.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$667.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$667.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$500.45
|
| Rate for Payer: Healthfirst Commercial |
$667.27
|
| Rate for Payer: Healthfirst Essential Plan |
$1,501.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$633.91
|
| Rate for Payer: Healthfirst QHP |
$667.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$467.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$667.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$567.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$467.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$667.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$500.45
|
| Rate for Payer: SOMOS Essential |
$500.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$667.27
|
|
|
PR DRESSING CHANGE UNDER ANESTHESIA
|
Professional
|
Both
|
$203.11
|
|
|
Service Code
|
HCPCS 15852
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$114.44 |
| Rate for Payer: Cash Price |
$51.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.15
|
| Rate for Payer: Healthfirst Commercial |
$50.86
|
| Rate for Payer: Healthfirst Essential Plan |
$114.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.32
|
| Rate for Payer: Healthfirst QHP |
$50.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.15
|
| Rate for Payer: SOMOS Essential |
$38.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.86
|
|
|
PR DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS
|
Professional
|
Both
|
$669.20
|
|
|
Service Code
|
HCPCS 41800
|
| Min. Negotiated Rate |
$130.35 |
| Max. Negotiated Rate |
$419.00 |
| Rate for Payer: Cash Price |
$182.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.66
|
| Rate for Payer: Healthfirst Commercial |
$186.22
|
| Rate for Payer: Healthfirst Essential Plan |
$419.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.91
|
| Rate for Payer: Healthfirst QHP |
$186.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.66
|
| Rate for Payer: SOMOS Essential |
$139.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.22
|
|
|
PR DRG ABSC CST HMTMA VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$831.78
|
|
|
Service Code
|
HCPCS 40801
|
| Min. Negotiated Rate |
$162.76 |
| Max. Negotiated Rate |
$523.15 |
| Rate for Payer: Cash Price |
$229.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$232.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$209.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$232.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$232.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.38
|
| Rate for Payer: Healthfirst Commercial |
$232.51
|
| Rate for Payer: Healthfirst Essential Plan |
$523.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$220.88
|
| Rate for Payer: Healthfirst QHP |
$232.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$162.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$232.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$197.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$162.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$232.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.38
|
| Rate for Payer: SOMOS Essential |
$174.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$232.51
|
|
|
PR DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL
|
Professional
|
Both
|
$501.69
|
|
|
Service Code
|
HCPCS 40800
|
| Min. Negotiated Rate |
$97.51 |
| Max. Negotiated Rate |
$313.43 |
| Rate for Payer: Cash Price |
$138.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$139.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$132.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$139.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$132.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.47
|
| Rate for Payer: Healthfirst Commercial |
$139.30
|
| Rate for Payer: Healthfirst Essential Plan |
$313.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$132.34
|
| Rate for Payer: Healthfirst QHP |
$139.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$139.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$118.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$139.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$104.47
|
| Rate for Payer: SOMOS Essential |
$104.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$139.30
|
|
|
PR DRG ABSC SUBMAXILLARY/SUBLINGUAL INTRAORAL
|
Professional
|
Both
|
$577.22
|
|
|
Service Code
|
HCPCS 42310
|
| Min. Negotiated Rate |
$109.33 |
| Max. Negotiated Rate |
$351.40 |
| Rate for Payer: Cash Price |
$156.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$156.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$148.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$156.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.14
|
| Rate for Payer: Healthfirst Commercial |
$156.18
|
| Rate for Payer: Healthfirst Essential Plan |
$351.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$148.37
|
| Rate for Payer: Healthfirst QHP |
$156.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$156.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.14
|
| Rate for Payer: SOMOS Essential |
$117.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.18
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV
|
Professional
|
Both
|
$2,226.53
|
|
|
Service Code
|
HCPCS 38305
|
| Min. Negotiated Rate |
$417.94 |
| Max. Negotiated Rate |
$1,343.36 |
| Rate for Payer: Cash Price |
$599.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$597.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$537.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$537.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$567.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$597.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$567.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$597.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$597.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$447.79
|
| Rate for Payer: Healthfirst Commercial |
$597.05
|
| Rate for Payer: Healthfirst Essential Plan |
$1,343.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$567.20
|
| Rate for Payer: Healthfirst QHP |
$597.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$417.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$597.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$507.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$417.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$597.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$447.79
|
| Rate for Payer: SOMOS Essential |
$447.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$597.05
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL
|
Professional
|
Both
|
$935.69
|
|
|
Service Code
|
HCPCS 38300
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$568.55 |
| Rate for Payer: Cash Price |
$253.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$252.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$227.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$227.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$240.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$252.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$240.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$252.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.52
|
| Rate for Payer: Healthfirst Commercial |
$252.69
|
| Rate for Payer: Healthfirst Essential Plan |
$568.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.06
|
| Rate for Payer: Healthfirst QHP |
$252.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$252.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$252.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189.52
|
| Rate for Payer: SOMOS Essential |
$189.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$252.69
|
|
|
PR DRG OF SKENE'S GLAND ABSCESS OR CYST
|
Professional
|
Both
|
$721.98
|
|
|
Service Code
|
HCPCS 53060
|
| Min. Negotiated Rate |
$136.48 |
| Max. Negotiated Rate |
$438.68 |
| Rate for Payer: Cash Price |
$195.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$194.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$175.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$194.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.23
|
| Rate for Payer: Healthfirst Commercial |
$194.97
|
| Rate for Payer: Healthfirst Essential Plan |
$438.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.22
|
| Rate for Payer: Healthfirst QHP |
$194.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$194.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$165.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$194.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.23
|
| Rate for Payer: SOMOS Essential |
$146.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$194.97
|
|
|
PR DRG PERINEAL URINARY XTRVASATION COMPLIC
|
Professional
|
Both
|
$2,718.80
|
|
|
Service Code
|
HCPCS 53085
|
| Min. Negotiated Rate |
$518.92 |
| Max. Negotiated Rate |
$1,667.95 |
| Rate for Payer: Cash Price |
$744.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$741.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$667.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$667.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$704.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$741.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$704.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$741.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$741.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$555.98
|
| Rate for Payer: Healthfirst Commercial |
$741.31
|
| Rate for Payer: Healthfirst Essential Plan |
$1,667.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$704.24
|
| Rate for Payer: Healthfirst QHP |
$741.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$518.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$741.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$630.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$518.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$741.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$555.98
|
| Rate for Payer: SOMOS Essential |
$555.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$741.31
|
|
|
PR DRG PERINEAL URINARY XTRVASATION UNCOMP SPX
|
Professional
|
Both
|
$1,769.57
|
|
|
Service Code
|
HCPCS 53080
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$1,087.61 |
| Rate for Payer: Cash Price |
$486.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$483.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$435.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$435.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$459.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$483.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$459.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$483.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$362.54
|
| Rate for Payer: Healthfirst Commercial |
$483.38
|
| Rate for Payer: Healthfirst Essential Plan |
$1,087.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$459.21
|
| Rate for Payer: Healthfirst QHP |
$483.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$338.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$483.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$410.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$338.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$483.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$362.54
|
| Rate for Payer: SOMOS Essential |
$362.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$483.38
|
|
|
PR DRG PRIVESICAL/PREVESICAL SPACE ABSC
|
Professional
|
Both
|
$1,720.71
|
|
|
Service Code
|
HCPCS 51080
|
| Min. Negotiated Rate |
$329.72 |
| Max. Negotiated Rate |
$1,059.82 |
| Rate for Payer: Cash Price |
$472.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$471.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$423.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$423.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$447.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$471.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$447.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$471.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$471.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$353.27
|
| Rate for Payer: Healthfirst Commercial |
$471.03
|
| Rate for Payer: Healthfirst Essential Plan |
$1,059.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$447.48
|
| Rate for Payer: Healthfirst QHP |
$471.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$329.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$471.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$400.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$329.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$471.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$353.27
|
| Rate for Payer: SOMOS Essential |
$353.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$471.03
|
|
|
PR DRG XTRAPERITONEAL LYMPHOCELE PERITON CAVITY OPN
|
Professional
|
Both
|
$3,480.44
|
|
|
Service Code
|
HCPCS 49062
|
| Min. Negotiated Rate |
$646.35 |
| Max. Negotiated Rate |
$2,077.54 |
| Rate for Payer: Cash Price |
$930.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$923.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$831.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$831.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$877.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$923.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$877.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$923.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$692.51
|
| Rate for Payer: Healthfirst Commercial |
$923.35
|
| Rate for Payer: Healthfirst Essential Plan |
$2,077.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$877.18
|
| Rate for Payer: Healthfirst QHP |
$923.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$646.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$923.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$784.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$646.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$923.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$692.51
|
| Rate for Payer: SOMOS Essential |
$692.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$923.35
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE
|
Professional
|
Both
|
$575.54
|
|
|
Service Code
|
HCPCS 16030
|
| Min. Negotiated Rate |
$109.89 |
| Max. Negotiated Rate |
$353.23 |
| Rate for Payer: Cash Price |
$155.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$156.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$156.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.74
|
| Rate for Payer: Healthfirst Commercial |
$156.99
|
| Rate for Payer: Healthfirst Essential Plan |
$353.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.14
|
| Rate for Payer: Healthfirst QHP |
$156.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$156.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.74
|
| Rate for Payer: SOMOS Essential |
$117.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.99
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM
|
Professional
|
Both
|
$474.36
|
|
|
Service Code
|
HCPCS 16025
|
| Min. Negotiated Rate |
$90.10 |
| Max. Negotiated Rate |
$289.62 |
| Rate for Payer: Cash Price |
$130.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.54
|
| Rate for Payer: Healthfirst Commercial |
$128.72
|
| Rate for Payer: Healthfirst Essential Plan |
$289.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.28
|
| Rate for Payer: Healthfirst QHP |
$128.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.54
|
| Rate for Payer: SOMOS Essential |
$96.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.72
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL
|
Professional
|
Both
|
$239.65
|
|
|
Service Code
|
HCPCS 16020
|
| Min. Negotiated Rate |
$45.84 |
| Max. Negotiated Rate |
$147.35 |
| Rate for Payer: Cash Price |
$65.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.12
|
| Rate for Payer: Healthfirst Commercial |
$65.49
|
| Rate for Payer: Healthfirst Essential Plan |
$147.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.22
|
| Rate for Payer: Healthfirst QHP |
$65.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.12
|
| Rate for Payer: SOMOS Essential |
$49.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.49
|
|
