|
PR TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP
|
Professional
|
Both
|
$4,578.53
|
|
|
Service Code
|
HCPCS 69633
|
| Min. Negotiated Rate |
$850.21 |
| Max. Negotiated Rate |
$2,732.80 |
| Rate for Payer: Cash Price |
$1,237.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,214.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,093.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,093.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,153.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,214.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,153.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,214.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,214.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$910.93
|
| Rate for Payer: Healthfirst Commercial |
$1,214.58
|
| Rate for Payer: Healthfirst Essential Plan |
$2,732.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,153.85
|
| Rate for Payer: Healthfirst QHP |
$1,214.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$850.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,214.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,032.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$850.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,214.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$910.93
|
| Rate for Payer: SOMOS Essential |
$910.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,214.58
|
|
|
PR TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ
|
Professional
|
Both
|
$3,876.43
|
|
|
Service Code
|
HCPCS 69631
|
| Min. Negotiated Rate |
$716.24 |
| Max. Negotiated Rate |
$2,302.20 |
| Rate for Payer: Cash Price |
$1,046.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,023.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$920.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$920.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$972.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,023.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$972.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,023.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,023.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$767.40
|
| Rate for Payer: Healthfirst Commercial |
$1,023.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,302.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$972.04
|
| Rate for Payer: Healthfirst QHP |
$1,023.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$716.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,023.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$869.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$716.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,023.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$767.40
|
| Rate for Payer: SOMOS Essential |
$767.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,023.20
|
|
|
PR TYMPANOSTOMY GENERAL ANESTHESIA
|
Professional
|
Both
|
$687.89
|
|
|
Service Code
|
HCPCS 69436
|
| Min. Negotiated Rate |
$130.31 |
| Max. Negotiated Rate |
$418.84 |
| Rate for Payer: Cash Price |
$188.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.61
|
| Rate for Payer: Healthfirst Commercial |
$186.15
|
| Rate for Payer: Healthfirst Essential Plan |
$418.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.84
|
| Rate for Payer: Healthfirst QHP |
$186.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.61
|
| Rate for Payer: SOMOS Essential |
$139.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.15
|
|
|
PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Professional
|
Both
|
$571.66
|
|
|
Service Code
|
HCPCS 69433
|
| Min. Negotiated Rate |
$108.24 |
| Max. Negotiated Rate |
$347.92 |
| Rate for Payer: Cash Price |
$156.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.97
|
| Rate for Payer: Healthfirst Commercial |
$154.63
|
| Rate for Payer: Healthfirst Essential Plan |
$347.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.90
|
| Rate for Payer: Healthfirst QHP |
$154.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.97
|
| Rate for Payer: SOMOS Essential |
$115.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.63
|
|
|
PR TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ
|
Professional
|
Both
|
$4,715.03
|
|
|
Service Code
|
HCPCS 69632
|
| Min. Negotiated Rate |
$870.88 |
| Max. Negotiated Rate |
$2,799.27 |
| Rate for Payer: Cash Price |
$1,267.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,244.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,119.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,119.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,181.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,244.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,181.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,244.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,244.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$933.09
|
| Rate for Payer: Healthfirst Commercial |
$1,244.12
|
| Rate for Payer: Healthfirst Essential Plan |
$2,799.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,181.91
|
| Rate for Payer: Healthfirst QHP |
$1,244.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$870.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,244.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,057.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$870.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,244.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$933.09
|
| Rate for Payer: SOMOS Essential |
$933.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,244.12
|
|
|
PR TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$5,628.00
|
|
|
Service Code
|
HCPCS 69635
|
| Min. Negotiated Rate |
$1,042.18 |
| Max. Negotiated Rate |
$3,349.87 |
| Rate for Payer: Cash Price |
$1,512.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,488.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,339.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,339.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,414.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,488.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,414.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,488.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,488.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,116.62
|
| Rate for Payer: Healthfirst Commercial |
$1,488.83
|
| Rate for Payer: Healthfirst Essential Plan |
$3,349.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,414.39
|
| Rate for Payer: Healthfirst QHP |
$1,488.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,042.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,488.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,265.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,042.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,488.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,116.62
|
| Rate for Payer: SOMOS Essential |
$1,116.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,488.83
|
|
|
PR TYMPP ANTRT/MASTOID W/OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$6,124.09
|
|
|
Service Code
|
HCPCS 69636
|
| Min. Negotiated Rate |
$1,137.96 |
| Max. Negotiated Rate |
$3,657.74 |
| Rate for Payer: Cash Price |
$1,649.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,625.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,463.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,463.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,544.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,625.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,544.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,625.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,625.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,219.24
|
| Rate for Payer: Healthfirst Commercial |
$1,625.66
|
| Rate for Payer: Healthfirst Essential Plan |
$3,657.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,544.38
|
| Rate for Payer: Healthfirst QHP |
$1,625.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,137.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,625.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,381.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,137.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,625.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,219.24
|
| Rate for Payer: SOMOS Essential |
$1,219.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,625.66
|
|
|
PR UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX
|
Professional
|
Both
|
$2,663.61
|
|
|
Service Code
|
HCPCS 49250
|
| Min. Negotiated Rate |
$497.80 |
| Max. Negotiated Rate |
$1,600.07 |
| Rate for Payer: Cash Price |
$714.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$711.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$640.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$640.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$675.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$711.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$675.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$711.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$711.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$533.36
|
| Rate for Payer: Healthfirst Commercial |
$711.14
|
| Rate for Payer: Healthfirst Essential Plan |
$1,600.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$675.58
|
| Rate for Payer: Healthfirst QHP |
$711.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$497.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$711.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$604.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$497.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$711.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$533.36
|
| Rate for Payer: SOMOS Essential |
$533.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$711.14
|
|
|
PR UNLISTED PREVENTIVE MEDICINE SERVICE
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 99429
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Amida Care Medicaid |
$17.00
|
|
|
PR UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS
|
Professional
|
Both
|
$2,114.95
|
|
|
Service Code
|
HCPCS 33214
|
| Min. Negotiated Rate |
$390.05 |
| Max. Negotiated Rate |
$1,253.72 |
| Rate for Payer: Cash Price |
$561.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$557.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$501.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$501.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$529.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$557.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$529.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$417.91
|
| Rate for Payer: Healthfirst Commercial |
$557.21
|
| Rate for Payer: Healthfirst Essential Plan |
$1,253.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$529.35
|
| Rate for Payer: Healthfirst QHP |
$557.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$390.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$557.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$473.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$390.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$557.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$417.91
|
| Rate for Payer: SOMOS Essential |
$417.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$557.21
|
|
|
PR URETERAL EMBOLIZATION/OCCLUSION W/IMG GID RS&I
|
Professional
|
Both
|
$735.14
|
|
|
Service Code
|
HCPCS 50705
|
| Min. Negotiated Rate |
$138.38 |
| Max. Negotiated Rate |
$444.78 |
| Rate for Payer: Cash Price |
$196.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$187.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$187.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.26
|
| Rate for Payer: Healthfirst Commercial |
$197.68
|
| Rate for Payer: Healthfirst Essential Plan |
$444.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$187.80
|
| Rate for Payer: Healthfirst QHP |
$197.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$197.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$168.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$148.26
|
| Rate for Payer: SOMOS Essential |
$148.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.68
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROSTOMY
|
Professional
|
Both
|
$1,266.86
|
|
|
Service Code
|
HCPCS 50951
|
| Min. Negotiated Rate |
$240.86 |
| Max. Negotiated Rate |
$774.20 |
| Rate for Payer: Cash Price |
$346.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$344.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$309.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$309.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$326.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$344.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$326.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$344.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$344.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$258.07
|
| Rate for Payer: Healthfirst Commercial |
$344.09
|
| Rate for Payer: Healthfirst Essential Plan |
$774.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$326.89
|
| Rate for Payer: Healthfirst QHP |
$344.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$240.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$344.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$292.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$240.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$344.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$258.07
|
| Rate for Payer: SOMOS Essential |
$258.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$344.09
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROSTOMY W/BIOPSY
|
Professional
|
Both
|
$1,454.22
|
|
|
Service Code
|
HCPCS 50955
|
| Min. Negotiated Rate |
$276.54 |
| Max. Negotiated Rate |
$888.86 |
| Rate for Payer: Cash Price |
$397.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$395.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$355.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$355.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$375.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$395.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$375.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$395.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$395.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$296.29
|
| Rate for Payer: Healthfirst Commercial |
$395.05
|
| Rate for Payer: Healthfirst Essential Plan |
$888.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$375.30
|
| Rate for Payer: Healthfirst QHP |
$395.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$276.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$395.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$335.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$276.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$395.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$296.29
|
| Rate for Payer: SOMOS Essential |
$296.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$395.05
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE
|
Professional
|
Both
|
$1,311.45
|
|
|
Service Code
|
HCPCS 50961
|
| Min. Negotiated Rate |
$247.02 |
| Max. Negotiated Rate |
$793.98 |
| Rate for Payer: Cash Price |
$357.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$352.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$317.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$317.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$335.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$352.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$335.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$352.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$264.66
|
| Rate for Payer: Healthfirst Commercial |
$352.88
|
| Rate for Payer: Healthfirst Essential Plan |
$793.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$335.24
|
| Rate for Payer: Healthfirst QHP |
$352.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$247.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$352.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$299.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$247.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$352.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$264.66
|
| Rate for Payer: SOMOS Essential |
$264.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$352.88
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROST W/WO DIL URETER
|
Professional
|
Both
|
$1,350.76
|
|
|
Service Code
|
HCPCS 50953
|
| Min. Negotiated Rate |
$256.75 |
| Max. Negotiated Rate |
$825.28 |
| Rate for Payer: Cash Price |
$367.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$366.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$330.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$330.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$348.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$366.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$348.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$366.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$366.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$275.09
|
| Rate for Payer: Healthfirst Commercial |
$366.79
|
| Rate for Payer: Healthfirst Essential Plan |
$825.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$348.45
|
| Rate for Payer: Healthfirst QHP |
$366.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$256.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$366.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$311.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$256.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$366.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$275.09
|
| Rate for Payer: SOMOS Essential |
$275.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$366.79
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROTOMY W/O IMAGING
|
Professional
|
Both
|
$1,529.68
|
|
|
Service Code
|
HCPCS 50970
|
| Min. Negotiated Rate |
$290.39 |
| Max. Negotiated Rate |
$933.39 |
| Rate for Payer: Cash Price |
$417.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$414.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$373.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$394.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$414.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$394.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$414.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$414.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$311.13
|
| Rate for Payer: Healthfirst Commercial |
$414.84
|
| Rate for Payer: Healthfirst Essential Plan |
$933.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$394.10
|
| Rate for Payer: Healthfirst QHP |
$414.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$290.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$414.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$352.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$290.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$414.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$311.13
|
| Rate for Payer: SOMOS Essential |
$311.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$414.84
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROT W/O IMAGING W/BX
|
Professional
|
Both
|
$1,954.26
|
|
|
Service Code
|
HCPCS 50974
|
| Min. Negotiated Rate |
$370.43 |
| Max. Negotiated Rate |
$1,190.65 |
| Rate for Payer: Cash Price |
$532.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$529.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$476.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$476.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$502.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$529.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$502.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$529.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$529.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$396.88
|
| Rate for Payer: Healthfirst Commercial |
$529.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,190.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$502.72
|
| Rate for Payer: Healthfirst QHP |
$529.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$370.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$529.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$449.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$370.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$529.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$396.88
|
| Rate for Payer: SOMOS Essential |
$396.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$529.18
|
|
|
PR URETERAL ENDOSCOPY W/DEST&/INC W/WO BIOPSY
|
Professional
|
Both
|
$1,463.39
|
|
|
Service Code
|
HCPCS 50957
|
| Min. Negotiated Rate |
$277.77 |
| Max. Negotiated Rate |
$892.85 |
| Rate for Payer: Cash Price |
$398.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$396.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$357.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$357.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$376.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$396.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$376.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.62
|
| Rate for Payer: Healthfirst Commercial |
$396.82
|
| Rate for Payer: Healthfirst Essential Plan |
$892.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$376.98
|
| Rate for Payer: Healthfirst QHP |
$396.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$277.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$396.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$337.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$277.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$396.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.62
|
| Rate for Payer: SOMOS Essential |
$297.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$396.82
|
|
|
PR URETERAL ENDOSC VIA URETEROT W/DEST&/INC W/WO BX
|
Professional
|
Both
|
$1,921.26
|
|
|
Service Code
|
HCPCS 50976
|
| Min. Negotiated Rate |
$365.34 |
| Max. Negotiated Rate |
$1,174.30 |
| Rate for Payer: Cash Price |
$525.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$521.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$469.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$469.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$495.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$521.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$495.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$521.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$521.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$391.43
|
| Rate for Payer: Healthfirst Commercial |
$521.91
|
| Rate for Payer: Healthfirst Essential Plan |
$1,174.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$495.81
|
| Rate for Payer: Healthfirst QHP |
$521.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$365.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$521.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$443.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$365.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$521.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$391.43
|
| Rate for Payer: SOMOS Essential |
$391.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$521.91
|
|
|
PR URETERECTOMY TOT ECTOPIC URETER CMBN APPR
|
Professional
|
Both
|
$4,760.28
|
|
|
Service Code
|
HCPCS 50660
|
| Min. Negotiated Rate |
$905.18 |
| Max. Negotiated Rate |
$2,909.52 |
| Rate for Payer: Cash Price |
$1,302.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,293.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,163.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,163.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,228.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,293.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,228.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,293.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,293.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$969.84
|
| Rate for Payer: Healthfirst Commercial |
$1,293.12
|
| Rate for Payer: Healthfirst Essential Plan |
$2,909.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,228.46
|
| Rate for Payer: Healthfirst QHP |
$1,293.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$905.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,293.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,099.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$905.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,293.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$969.84
|
| Rate for Payer: SOMOS Essential |
$969.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,293.12
|
|
|
PR URETEROCALYCOSTOMY ANAST URETER RENAL CALYX
|
Professional
|
Both
|
$4,803.58
|
|
|
Service Code
|
HCPCS 50750
|
| Min. Negotiated Rate |
$913.48 |
| Max. Negotiated Rate |
$2,936.18 |
| Rate for Payer: Cash Price |
$1,313.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,304.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,174.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,174.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,239.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,304.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,239.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,304.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,304.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$978.73
|
| Rate for Payer: Healthfirst Commercial |
$1,304.97
|
| Rate for Payer: Healthfirst Essential Plan |
$2,936.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,239.72
|
| Rate for Payer: Healthfirst QHP |
$1,304.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$913.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,304.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,109.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$913.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,304.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$978.73
|
| Rate for Payer: SOMOS Essential |
$978.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,304.97
|
|
|
PR URETEROCOLON CONDUIT INTESTINE ANASTOMOSIS
|
Professional
|
Both
|
$5,110.14
|
|
|
Service Code
|
HCPCS 50815
|
| Min. Negotiated Rate |
$971.47 |
| Max. Negotiated Rate |
$3,122.57 |
| Rate for Payer: Cash Price |
$1,396.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,387.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,249.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,249.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,318.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,387.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,318.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,387.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,387.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,040.86
|
| Rate for Payer: Healthfirst Commercial |
$1,387.81
|
| Rate for Payer: Healthfirst Essential Plan |
$3,122.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,318.42
|
| Rate for Payer: Healthfirst QHP |
$1,387.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$971.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,387.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,179.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$971.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,387.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,040.86
|
| Rate for Payer: SOMOS Essential |
$1,040.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,387.81
|
|
|
PR URETEROENTEROSTOMY ANAST URETER INTESTINE
|
Professional
|
Both
|
$3,892.46
|
|
|
Service Code
|
HCPCS 50800
|
| Min. Negotiated Rate |
$734.08 |
| Max. Negotiated Rate |
$2,359.55 |
| Rate for Payer: Cash Price |
$1,054.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$943.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$943.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$996.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$996.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,048.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$786.52
|
| Rate for Payer: Healthfirst Commercial |
$1,048.69
|
| Rate for Payer: Healthfirst Essential Plan |
$2,359.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$996.26
|
| Rate for Payer: Healthfirst QHP |
$1,048.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$734.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,048.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$891.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$734.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$786.52
|
| Rate for Payer: SOMOS Essential |
$786.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.69
|
|
|
PR URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS
|
Professional
|
Both
|
$5,504.07
|
|
|
Service Code
|
HCPCS 50820
|
| Min. Negotiated Rate |
$1,043.72 |
| Max. Negotiated Rate |
$3,354.82 |
| Rate for Payer: Cash Price |
$1,499.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,491.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,341.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,341.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,416.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,491.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,416.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,491.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,491.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,118.27
|
| Rate for Payer: Healthfirst Commercial |
$1,491.03
|
| Rate for Payer: Healthfirst Essential Plan |
$3,354.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,416.48
|
| Rate for Payer: Healthfirst QHP |
$1,491.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,043.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,491.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,267.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,043.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,491.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,118.27
|
| Rate for Payer: SOMOS Essential |
$1,118.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,491.03
|
|
|
PR URETEROLYSIS FOR OVARIAN VEIN SYNDROME
|
Professional
|
Both
|
$4,433.80
|
|
|
Service Code
|
HCPCS 50722
|
| Min. Negotiated Rate |
$825.95 |
| Max. Negotiated Rate |
$2,654.84 |
| Rate for Payer: Cash Price |
$1,194.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,179.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,061.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,061.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,120.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,179.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,120.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,179.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,179.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$884.95
|
| Rate for Payer: Healthfirst Commercial |
$1,179.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,654.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,120.93
|
| Rate for Payer: Healthfirst QHP |
$1,179.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$825.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,179.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,002.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$825.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,179.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$884.95
|
| Rate for Payer: SOMOS Essential |
$884.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,179.93
|
|
