|
PR HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN
|
Professional
|
Both
|
$846.34
|
|
|
Service Code
|
HCPCS 99236
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$513.70 |
| Rate for Payer: Amida Care Medicaid |
$83.26
|
| Rate for Payer: Cash Price |
$231.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.23
|
| Rate for Payer: Healthfirst Commercial |
$228.31
|
| Rate for Payer: Healthfirst Essential Plan |
$513.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.89
|
| Rate for Payer: Healthfirst QHP |
$228.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.23
|
| Rate for Payer: SOMOS Essential |
$171.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.31
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN
|
Professional
|
Both
|
$646.98
|
|
|
Service Code
|
HCPCS 99235
|
| Min. Negotiated Rate |
$66.96 |
| Max. Negotiated Rate |
$392.81 |
| Rate for Payer: Amida Care Medicaid |
$66.96
|
| Rate for Payer: Cash Price |
$177.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$174.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$157.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$157.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$165.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$174.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$165.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.94
|
| Rate for Payer: Healthfirst Commercial |
$174.58
|
| Rate for Payer: Healthfirst Essential Plan |
$392.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$165.85
|
| Rate for Payer: Healthfirst QHP |
$174.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$122.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$174.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$148.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$122.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$174.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.94
|
| Rate for Payer: SOMOS Essential |
$130.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$174.58
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN
|
Professional
|
Both
|
$406.11
|
|
|
Service Code
|
HCPCS 99234
|
| Min. Negotiated Rate |
$50.82 |
| Max. Negotiated Rate |
$241.90 |
| Rate for Payer: Amida Care Medicaid |
$50.82
|
| Rate for Payer: Cash Price |
$109.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.63
|
| Rate for Payer: Healthfirst Commercial |
$107.51
|
| Rate for Payer: Healthfirst Essential Plan |
$241.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.13
|
| Rate for Payer: Healthfirst QHP |
$107.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.63
|
| Rate for Payer: SOMOS Essential |
$80.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.51
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN
|
Professional
|
Both
|
$469.60
|
|
|
Service Code
|
HCPCS 99239
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$285.84 |
| Rate for Payer: Amida Care Medicaid |
$38.71
|
| Rate for Payer: Cash Price |
$127.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.28
|
| Rate for Payer: Healthfirst Commercial |
$127.04
|
| Rate for Payer: Healthfirst Essential Plan |
$285.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.69
|
| Rate for Payer: Healthfirst QHP |
$127.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.28
|
| Rate for Payer: SOMOS Essential |
$95.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.04
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<
|
Professional
|
Both
|
$330.09
|
|
|
Service Code
|
HCPCS 99238
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$202.81 |
| Rate for Payer: Amida Care Medicaid |
$27.01
|
| Rate for Payer: Cash Price |
$90.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.61
|
| Rate for Payer: Healthfirst Commercial |
$90.14
|
| Rate for Payer: Healthfirst Essential Plan |
$202.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.63
|
| Rate for Payer: Healthfirst QHP |
$90.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.61
|
| Rate for Payer: SOMOS Essential |
$67.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.14
|
|
|
PR HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY
|
Professional
|
Both
|
$2,170.70
|
|
|
Service Code
|
HCPCS 46258
|
| Min. Negotiated Rate |
$407.31 |
| Max. Negotiated Rate |
$1,309.21 |
| Rate for Payer: Cash Price |
$584.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$581.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$523.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$523.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$552.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$581.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$552.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$581.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$581.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$436.40
|
| Rate for Payer: Healthfirst Commercial |
$581.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,309.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$552.78
|
| Rate for Payer: Healthfirst QHP |
$581.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$407.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$581.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$494.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$407.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$581.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$436.40
|
| Rate for Payer: SOMOS Essential |
$436.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$581.87
|
|
|
PR HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY
|
Professional
|
Both
|
$2,649.26
|
|
|
Service Code
|
HCPCS 46262
|
| Min. Negotiated Rate |
$495.24 |
| Max. Negotiated Rate |
$1,591.85 |
| Rate for Payer: Cash Price |
$708.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$707.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$636.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$636.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$672.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$707.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$672.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$707.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$707.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$530.62
|
| Rate for Payer: Healthfirst Commercial |
$707.49
|
| Rate for Payer: Healthfirst Essential Plan |
$1,591.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$672.12
|
| Rate for Payer: Healthfirst QHP |
$707.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$495.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$707.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$601.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$495.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$707.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$530.62
|
| Rate for Payer: SOMOS Essential |
$530.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$707.49
|
|
|
PR HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU
|
Professional
|
Both
|
$2,319.84
|
|
|
Service Code
|
HCPCS 46261
|
| Min. Negotiated Rate |
$439.80 |
| Max. Negotiated Rate |
$1,413.63 |
| Rate for Payer: Cash Price |
$632.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$628.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$565.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$565.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$628.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$628.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$628.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$471.21
|
| Rate for Payer: Healthfirst Commercial |
$628.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,413.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$596.87
|
| Rate for Payer: Healthfirst QHP |
$628.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$439.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$628.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$534.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$439.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$628.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$471.21
|
| Rate for Payer: SOMOS Essential |
$471.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$628.28
|
|
|
PR HYMENOTOMY SIMPLE INCISION
|
Professional
|
Both
|
$207.13
|
|
|
Service Code
|
HCPCS 56442
|
| Min. Negotiated Rate |
$39.41 |
| Max. Negotiated Rate |
$126.67 |
| Rate for Payer: Cash Price |
$55.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.23
|
| Rate for Payer: Healthfirst Commercial |
$56.30
|
| Rate for Payer: Healthfirst Essential Plan |
$126.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.48
|
| Rate for Payer: Healthfirst QHP |
$56.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.23
|
| Rate for Payer: SOMOS Essential |
$42.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.30
|
|
|
PR HYOID MYOTOMY & SUSPENSION
|
Professional
|
Both
|
$4,235.91
|
|
|
Service Code
|
HCPCS 21685
|
| Min. Negotiated Rate |
$794.01 |
| Max. Negotiated Rate |
$2,552.18 |
| Rate for Payer: Cash Price |
$1,147.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,134.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,020.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,020.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,077.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,134.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,077.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,134.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,134.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$850.73
|
| Rate for Payer: Healthfirst Commercial |
$1,134.30
|
| Rate for Payer: Healthfirst Essential Plan |
$2,552.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,077.59
|
| Rate for Payer: Healthfirst QHP |
$1,134.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$794.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,134.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$964.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$794.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,134.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$850.73
|
| Rate for Payer: SOMOS Essential |
$850.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,134.30
|
|
|
PR HYPNOTHERAPY
|
Professional
|
Both
|
$338.14
|
|
|
Service Code
|
HCPCS 90880
|
| Min. Negotiated Rate |
$63.13 |
| Max. Negotiated Rate |
$202.91 |
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.64
|
| Rate for Payer: Healthfirst Commercial |
$90.18
|
| Rate for Payer: Healthfirst Essential Plan |
$202.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.67
|
| Rate for Payer: Healthfirst QHP |
$90.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.64
|
| Rate for Payer: SOMOS Essential |
$67.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.18
|
|
|
PR HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL
|
Professional
|
Both
|
$7,375.69
|
|
|
Service Code
|
HCPCS 61548
|
| Min. Negotiated Rate |
$1,356.66 |
| Max. Negotiated Rate |
$4,360.70 |
| Rate for Payer: Cash Price |
$1,959.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,938.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,744.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,744.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,841.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,938.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,841.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,938.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,938.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,453.57
|
| Rate for Payer: Healthfirst Commercial |
$1,938.09
|
| Rate for Payer: Healthfirst Essential Plan |
$4,360.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,841.19
|
| Rate for Payer: Healthfirst QHP |
$1,938.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,356.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,938.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,647.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,356.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,938.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,453.57
|
| Rate for Payer: SOMOS Essential |
$1,453.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,938.09
|
|
|
PR HYSTEROPLASTY RPR UTERINE ANOMALY
|
Professional
|
Both
|
$3,999.10
|
|
|
Service Code
|
HCPCS 58540
|
| Min. Negotiated Rate |
$744.13 |
| Max. Negotiated Rate |
$2,391.84 |
| Rate for Payer: Cash Price |
$1,078.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,063.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$956.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$956.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,009.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,063.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,009.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,063.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,063.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$797.28
|
| Rate for Payer: Healthfirst Commercial |
$1,063.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,391.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,009.89
|
| Rate for Payer: Healthfirst QHP |
$1,063.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$744.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,063.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$903.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$744.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,063.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$797.28
|
| Rate for Payer: SOMOS Essential |
$797.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,063.04
|
|
|
PR HYSTERORRHAPHY REPAIR RUPT UTERUS NONOBSTETRICAL
|
Professional
|
Both
|
$3,497.24
|
|
|
Service Code
|
HCPCS 58520
|
| Min. Negotiated Rate |
$647.94 |
| Max. Negotiated Rate |
$2,082.67 |
| Rate for Payer: Cash Price |
$939.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$925.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$833.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$833.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$879.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$925.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$879.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$925.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$925.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$694.22
|
| Rate for Payer: Healthfirst Commercial |
$925.63
|
| Rate for Payer: Healthfirst Essential Plan |
$2,082.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$879.35
|
| Rate for Payer: Healthfirst QHP |
$925.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$647.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$925.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$786.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$647.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$925.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$694.22
|
| Rate for Payer: SOMOS Essential |
$694.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$925.63
|
|
|
PR HYSTERORRHAPHY RUPTURED UTERUS
|
Professional
|
Both
|
$1,300.99
|
|
|
Service Code
|
HCPCS 59350
|
| Min. Negotiated Rate |
$235.66 |
| Max. Negotiated Rate |
$757.46 |
| Rate for Payer: Cash Price |
$342.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$302.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$302.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$319.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$319.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$336.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.49
|
| Rate for Payer: Healthfirst Commercial |
$336.65
|
| Rate for Payer: Healthfirst Essential Plan |
$757.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$319.82
|
| Rate for Payer: Healthfirst QHP |
$336.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$235.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$286.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$235.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.49
|
| Rate for Payer: SOMOS Essential |
$252.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.65
|
|
|
PR HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS
|
Professional
|
Both
|
$2,002.39
|
|
|
Service Code
|
HCPCS 58565
|
| Min. Negotiated Rate |
$371.38 |
| Max. Negotiated Rate |
$1,193.71 |
| Rate for Payer: Cash Price |
$540.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$530.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$477.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$477.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$504.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$530.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$504.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$530.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$530.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$397.90
|
| Rate for Payer: Healthfirst Commercial |
$530.54
|
| Rate for Payer: Healthfirst Essential Plan |
$1,193.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$504.01
|
| Rate for Payer: Healthfirst QHP |
$530.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$371.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$530.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$450.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$371.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$530.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$397.90
|
| Rate for Payer: SOMOS Essential |
$397.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$530.54
|
|
|
PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C
|
Professional
|
Both
|
$1,002.89
|
|
|
Service Code
|
HCPCS 58558
|
| Min. Negotiated Rate |
$187.25 |
| Max. Negotiated Rate |
$601.88 |
| Rate for Payer: Cash Price |
$270.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$267.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$267.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.62
|
| Rate for Payer: Healthfirst Commercial |
$267.50
|
| Rate for Payer: Healthfirst Essential Plan |
$601.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$254.12
|
| Rate for Payer: Healthfirst QHP |
$267.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$187.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$267.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$227.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$187.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$267.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.62
|
| Rate for Payer: SOMOS Essential |
$200.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$267.50
|
|
|
PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$656.43
|
|
|
Service Code
|
HCPCS 58555
|
| Min. Negotiated Rate |
$123.64 |
| Max. Negotiated Rate |
$397.42 |
| Rate for Payer: Cash Price |
$176.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$176.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$176.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$176.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$176.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.47
|
| Rate for Payer: Healthfirst Commercial |
$176.63
|
| Rate for Payer: Healthfirst Essential Plan |
$397.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.80
|
| Rate for Payer: Healthfirst QHP |
$176.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$176.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$150.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$176.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.47
|
| Rate for Payer: SOMOS Essential |
$132.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.63
|
|
|
PR HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM
|
Professional
|
Both
|
$1,352.58
|
|
|
Service Code
|
HCPCS 58560
|
| Min. Negotiated Rate |
$252.09 |
| Max. Negotiated Rate |
$810.29 |
| Rate for Payer: Cash Price |
$364.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$324.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$342.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$342.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$360.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$270.10
|
| Rate for Payer: Healthfirst Commercial |
$360.13
|
| Rate for Payer: Healthfirst Essential Plan |
$810.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$342.12
|
| Rate for Payer: Healthfirst QHP |
$360.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$252.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$360.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$306.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$252.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$270.10
|
| Rate for Payer: SOMOS Essential |
$270.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.13
|
|
|
PR HYSTEROSCOPY ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$1,067.08
|
|
|
Service Code
|
HCPCS 58563
|
| Min. Negotiated Rate |
$198.23 |
| Max. Negotiated Rate |
$637.15 |
| Rate for Payer: Cash Price |
$286.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$254.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$254.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$269.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$269.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$283.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$212.38
|
| Rate for Payer: Healthfirst Commercial |
$283.18
|
| Rate for Payer: Healthfirst Essential Plan |
$637.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$269.02
|
| Rate for Payer: Healthfirst QHP |
$283.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$198.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$283.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$240.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$198.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$212.38
|
| Rate for Payer: SOMOS Essential |
$212.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.18
|
|
|
PR HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS
|
Professional
|
Both
|
$1,227.56
|
|
|
Service Code
|
HCPCS 58559
|
| Min. Negotiated Rate |
$228.79 |
| Max. Negotiated Rate |
$735.41 |
| Rate for Payer: Cash Price |
$331.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$326.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$294.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$294.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$310.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$326.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$310.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$326.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$245.14
|
| Rate for Payer: Healthfirst Commercial |
$326.85
|
| Rate for Payer: Healthfirst Essential Plan |
$735.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.51
|
| Rate for Payer: Healthfirst QHP |
$326.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$228.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$326.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$277.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$228.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$326.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$245.14
|
| Rate for Payer: SOMOS Essential |
$245.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$326.85
|
|
|
PR HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY
|
Professional
|
Both
|
$960.47
|
|
|
Service Code
|
HCPCS 58562
|
| Min. Negotiated Rate |
$178.54 |
| Max. Negotiated Rate |
$573.88 |
| Rate for Payer: Cash Price |
$258.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$255.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$229.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$229.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$255.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.29
|
| Rate for Payer: Healthfirst Commercial |
$255.06
|
| Rate for Payer: Healthfirst Essential Plan |
$573.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.31
|
| Rate for Payer: Healthfirst QHP |
$255.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$178.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$255.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$216.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$178.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$255.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.29
|
| Rate for Payer: SOMOS Essential |
$191.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.06
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$1,551.69
|
|
|
Service Code
|
HCPCS 58561
|
| Min. Negotiated Rate |
$288.43 |
| Max. Negotiated Rate |
$927.09 |
| Rate for Payer: Cash Price |
$417.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$412.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$370.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$370.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$391.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$412.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$391.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$412.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$412.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$309.03
|
| Rate for Payer: Healthfirst Commercial |
$412.04
|
| Rate for Payer: Healthfirst Essential Plan |
$927.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.44
|
| Rate for Payer: Healthfirst QHP |
$412.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$288.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$412.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$350.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$288.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$412.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$309.03
|
| Rate for Payer: SOMOS Essential |
$309.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$412.04
|
|
|
PR HYSTEROTOMY ABDOMINAL
|
Professional
|
Both
|
$3,976.81
|
|
|
Service Code
|
HCPCS 59100
|
| Min. Negotiated Rate |
$727.84 |
| Max. Negotiated Rate |
$2,339.48 |
| Rate for Payer: Cash Price |
$1,056.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,039.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$935.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$935.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$987.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,039.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$987.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,039.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,039.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$779.83
|
| Rate for Payer: Healthfirst Commercial |
$1,039.77
|
| Rate for Payer: Healthfirst Essential Plan |
$2,339.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$987.78
|
| Rate for Payer: Healthfirst QHP |
$1,039.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$727.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,039.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$883.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$727.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,039.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$779.83
|
| Rate for Payer: SOMOS Essential |
$779.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,039.77
|
|
|
PR ICAR CATH ABLATION DISCRETE MECHANISM ARRHYTHMIA
|
Professional
|
Both
|
$1,357.76
|
|
|
Service Code
|
HCPCS 93655
|
| Min. Negotiated Rate |
$214.72 |
| Max. Negotiated Rate |
$794.92 |
| Rate for Payer: Amida Care Medicaid |
$214.72
|
| Rate for Payer: Cash Price |
$356.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$353.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$317.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$317.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$335.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$353.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$335.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$353.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$353.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$264.98
|
| Rate for Payer: Healthfirst Commercial |
$353.30
|
| Rate for Payer: Healthfirst Essential Plan |
$794.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$335.63
|
| Rate for Payer: Healthfirst QHP |
$353.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$247.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$353.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$300.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$247.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$353.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$264.98
|
| Rate for Payer: SOMOS Essential |
$264.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$353.30
|
|
