|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE
|
Professional
|
Both
|
$2,040.12
|
|
|
Service Code
|
HCPCS 53505
|
| Min. Negotiated Rate |
$390.43 |
| Max. Negotiated Rate |
$1,254.94 |
| Rate for Payer: Cash Price |
$560.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$557.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$501.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$501.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$529.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$557.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$529.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$418.31
|
| Rate for Payer: Healthfirst Commercial |
$557.75
|
| Rate for Payer: Healthfirst Essential Plan |
$1,254.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$529.86
|
| Rate for Payer: Healthfirst QHP |
$557.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$390.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$557.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$474.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$390.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$557.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$418.31
|
| Rate for Payer: SOMOS Essential |
$418.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$557.75
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PERINEAL
|
Professional
|
Both
|
$2,654.16
|
|
|
Service Code
|
HCPCS 53510
|
| Min. Negotiated Rate |
$507.04 |
| Max. Negotiated Rate |
$1,629.77 |
| Rate for Payer: Cash Price |
$727.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$724.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$651.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$651.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$688.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$724.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$688.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$724.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$724.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$543.25
|
| Rate for Payer: Healthfirst Commercial |
$724.34
|
| Rate for Payer: Healthfirst Essential Plan |
$1,629.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$688.12
|
| Rate for Payer: Healthfirst QHP |
$724.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$507.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$724.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$615.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$507.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$724.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$543.25
|
| Rate for Payer: SOMOS Essential |
$543.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$724.34
|
|
|
PR URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA
|
Professional
|
Both
|
$1,252.93
|
|
|
Service Code
|
HCPCS 53010
|
| Min. Negotiated Rate |
$241.42 |
| Max. Negotiated Rate |
$776.00 |
| Rate for Payer: Cash Price |
$345.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$344.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$310.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$310.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$327.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$344.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$327.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$344.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$344.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$258.67
|
| Rate for Payer: Healthfirst Commercial |
$344.89
|
| Rate for Payer: Healthfirst Essential Plan |
$776.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$327.65
|
| Rate for Payer: Healthfirst QHP |
$344.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$241.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$344.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$293.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$241.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$344.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$258.67
|
| Rate for Payer: SOMOS Essential |
$258.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$344.89
|
|
|
PR URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,340.32
|
|
|
Service Code
|
HCPCS 50650
|
| Min. Negotiated Rate |
$825.16 |
| Max. Negotiated Rate |
$2,652.30 |
| Rate for Payer: Cash Price |
$1,189.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,178.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,060.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,060.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,119.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,178.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,119.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,178.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,178.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$884.10
|
| Rate for Payer: Healthfirst Commercial |
$1,178.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,652.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,119.86
|
| Rate for Payer: Healthfirst QHP |
$1,178.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$825.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,178.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,001.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$825.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,178.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$884.10
|
| Rate for Payer: SOMOS Essential |
$884.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,178.80
|
|
|
PR URINALYSIS, NONAUTO, W/SCOPE
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 81000
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$9.04 |
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.02
|
| Rate for Payer: Healthfirst Commercial |
$4.02
|
| Rate for Payer: Healthfirst Essential Plan |
$9.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.82
|
| Rate for Payer: Healthfirst QHP |
$4.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.61
|
| Rate for Payer: SOMOS Essential |
$1.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.02
|
|
|
PR URINARY UNIDIVERSION
|
Professional
|
Both
|
$7,495.85
|
|
|
Service Code
|
HCPCS 50830
|
| Min. Negotiated Rate |
$1,422.52 |
| Max. Negotiated Rate |
$4,572.38 |
| Rate for Payer: Cash Price |
$2,044.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,032.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,828.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,828.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,930.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,032.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,930.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,032.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,032.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,524.13
|
| Rate for Payer: Healthfirst Commercial |
$2,032.17
|
| Rate for Payer: Healthfirst Essential Plan |
$4,572.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,930.56
|
| Rate for Payer: Healthfirst QHP |
$2,032.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,422.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,032.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,727.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,422.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,032.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,524.13
|
| Rate for Payer: SOMOS Essential |
$1,524.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,032.17
|
|
|
PR URTORR SUTR URETHRAL WND/INJ PROSTATOMEMBRANOUS
|
Professional
|
Both
|
$3,328.75
|
|
|
Service Code
|
HCPCS 53515
|
| Min. Negotiated Rate |
$633.88 |
| Max. Negotiated Rate |
$2,037.49 |
| Rate for Payer: Cash Price |
$910.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$905.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$815.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$815.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$860.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$905.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$860.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$905.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$905.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$679.16
|
| Rate for Payer: Healthfirst Commercial |
$905.55
|
| Rate for Payer: Healthfirst Essential Plan |
$2,037.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$860.27
|
| Rate for Payer: Healthfirst QHP |
$905.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$633.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$905.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$769.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$633.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$905.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$679.16
|
| Rate for Payer: SOMOS Essential |
$679.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$905.55
|
|
|
PR URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 1ST STAGE
|
Professional
|
Both
|
$3,513.90
|
|
|
Service Code
|
HCPCS 53420
|
| Min. Negotiated Rate |
$668.02 |
| Max. Negotiated Rate |
$2,147.22 |
| Rate for Payer: Cash Price |
$960.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$954.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$858.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$858.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$954.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$954.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$715.74
|
| Rate for Payer: Healthfirst Commercial |
$954.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,147.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$906.60
|
| Rate for Payer: Healthfirst QHP |
$954.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$668.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$954.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$811.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$668.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$954.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$715.74
|
| Rate for Payer: SOMOS Essential |
$715.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$954.32
|
|
|
PR URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE
|
Professional
|
Both
|
$3,910.97
|
|
|
Service Code
|
HCPCS 53425
|
| Min. Negotiated Rate |
$743.57 |
| Max. Negotiated Rate |
$2,390.04 |
| Rate for Payer: Cash Price |
$1,068.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,062.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$956.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$956.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,009.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,062.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,009.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,062.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,062.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$796.68
|
| Rate for Payer: Healthfirst Commercial |
$1,062.24
|
| Rate for Payer: Healthfirst Essential Plan |
$2,390.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,009.13
|
| Rate for Payer: Healthfirst QHP |
$1,062.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$743.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,062.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$902.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$743.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,062.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$796.68
|
| Rate for Payer: SOMOS Essential |
$796.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,062.24
|
|
|
PR URTP TRANSPUBIC/PRNL 1 STG RCNSTJ/RPR URT
|
Professional
|
Both
|
$4,714.57
|
|
|
Service Code
|
HCPCS 53415
|
| Min. Negotiated Rate |
$894.92 |
| Max. Negotiated Rate |
$2,876.53 |
| Rate for Payer: Cash Price |
$1,287.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,278.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,150.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,150.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,214.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,278.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,214.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,278.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,278.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$958.85
|
| Rate for Payer: Healthfirst Commercial |
$1,278.46
|
| Rate for Payer: Healthfirst Essential Plan |
$2,876.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,214.54
|
| Rate for Payer: Healthfirst QHP |
$1,278.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$894.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,278.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,086.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$894.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,278.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$958.85
|
| Rate for Payer: SOMOS Essential |
$958.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,278.46
|
|
|
PR URTP W/TUBULARIZATION POST URT&/LWR BLDR
|
Professional
|
Both
|
$4,805.78
|
|
|
Service Code
|
HCPCS 53431
|
| Min. Negotiated Rate |
$913.60 |
| Max. Negotiated Rate |
$2,936.57 |
| Rate for Payer: Cash Price |
$1,313.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,305.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,174.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,174.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,239.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,305.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,239.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,305.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,305.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$978.86
|
| Rate for Payer: Healthfirst Commercial |
$1,305.14
|
| Rate for Payer: Healthfirst Essential Plan |
$2,936.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,239.88
|
| Rate for Payer: Healthfirst QHP |
$1,305.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$913.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,305.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,109.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$913.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,305.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$978.86
|
| Rate for Payer: SOMOS Essential |
$978.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,305.14
|
|
|
PR URTROLITHOTOMY LOWER ONE-THIRD URETER
|
Professional
|
Both
|
$3,727.05
|
|
|
Service Code
|
HCPCS 50630
|
| Min. Negotiated Rate |
$708.83 |
| Max. Negotiated Rate |
$2,278.37 |
| Rate for Payer: Cash Price |
$1,019.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,012.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$911.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$911.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$961.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,012.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$961.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,012.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,012.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$759.46
|
| Rate for Payer: Healthfirst Commercial |
$1,012.61
|
| Rate for Payer: Healthfirst Essential Plan |
$2,278.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$961.98
|
| Rate for Payer: Healthfirst QHP |
$1,012.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$708.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,012.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$860.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$708.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,012.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$759.46
|
| Rate for Payer: SOMOS Essential |
$759.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,012.61
|
|
|
PR URTROLITHOTOMY MIDDLE ONE-THIRD URETER
|
Professional
|
Both
|
$3,772.86
|
|
|
Service Code
|
HCPCS 50620
|
| Min. Negotiated Rate |
$717.17 |
| Max. Negotiated Rate |
$2,305.19 |
| Rate for Payer: Cash Price |
$1,030.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,024.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$922.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$922.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$973.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,024.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$973.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,024.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,024.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$768.40
|
| Rate for Payer: Healthfirst Commercial |
$1,024.53
|
| Rate for Payer: Healthfirst Essential Plan |
$2,305.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$973.30
|
| Rate for Payer: Healthfirst QHP |
$1,024.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$717.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,024.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$870.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$717.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,024.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$768.40
|
| Rate for Payer: SOMOS Essential |
$768.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,024.53
|
|
|
PR URTROLITHOTOMY UPPER ONE-THIRD URETER
|
Professional
|
Both
|
$3,941.88
|
|
|
Service Code
|
HCPCS 50610
|
| Min. Negotiated Rate |
$750.29 |
| Max. Negotiated Rate |
$2,411.64 |
| Rate for Payer: Cash Price |
$1,077.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,071.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$964.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$964.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,018.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,071.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,018.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,071.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,071.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$803.88
|
| Rate for Payer: Healthfirst Commercial |
$1,071.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,411.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,018.25
|
| Rate for Payer: Healthfirst QHP |
$1,071.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$750.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,071.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$911.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$750.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,071.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$803.88
|
| Rate for Payer: SOMOS Essential |
$803.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,071.84
|
|
|
PR URTROLSS RETROCAVAL URTR W/REANAST
|
Professional
|
Both
|
$4,598.16
|
|
|
Service Code
|
HCPCS 50725
|
| Min. Negotiated Rate |
$873.20 |
| Max. Negotiated Rate |
$2,806.72 |
| Rate for Payer: Cash Price |
$1,255.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,247.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,122.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,122.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,185.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,247.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,185.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,247.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,247.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$935.57
|
| Rate for Payer: Healthfirst Commercial |
$1,247.43
|
| Rate for Payer: Healthfirst Essential Plan |
$2,806.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,185.06
|
| Rate for Payer: Healthfirst QHP |
$1,247.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$873.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,247.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,060.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$873.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,247.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$935.57
|
| Rate for Payer: SOMOS Essential |
$935.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,247.43
|
|
|
PR URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP
|
Professional
|
Both
|
$5,101.92
|
|
|
Service Code
|
HCPCS 50785
|
| Min. Negotiated Rate |
$968.78 |
| Max. Negotiated Rate |
$3,113.93 |
| Rate for Payer: Cash Price |
$1,385.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,383.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,245.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,245.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,314.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,383.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,314.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,383.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,383.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,037.98
|
| Rate for Payer: Healthfirst Commercial |
$1,383.97
|
| Rate for Payer: Healthfirst Essential Plan |
$3,113.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,314.77
|
| Rate for Payer: Healthfirst QHP |
$1,383.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$968.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,383.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,176.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$968.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,383.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,037.98
|
| Rate for Payer: SOMOS Essential |
$1,037.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,383.97
|
|
|
PR URTROTOMY W/EXPL/DRG SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,913.32
|
|
|
Service Code
|
HCPCS 50600
|
| Min. Negotiated Rate |
$744.67 |
| Max. Negotiated Rate |
$2,393.57 |
| Rate for Payer: Cash Price |
$1,069.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,063.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$957.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$957.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,010.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,063.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,010.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,063.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,063.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$797.86
|
| Rate for Payer: Healthfirst Commercial |
$1,063.81
|
| Rate for Payer: Healthfirst Essential Plan |
$2,393.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,010.62
|
| Rate for Payer: Healthfirst QHP |
$1,063.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$744.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,063.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$904.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$744.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,063.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$797.86
|
| Rate for Payer: SOMOS Essential |
$797.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,063.81
|
|
|
PR URTT/URTS XTRNL SPX PENDULOUS URETHRA
|
Professional
|
Both
|
$623.00
|
|
|
Service Code
|
HCPCS 53000
|
| Min. Negotiated Rate |
$119.39 |
| Max. Negotiated Rate |
$383.74 |
| Rate for Payer: Cash Price |
$172.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$170.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.91
|
| Rate for Payer: Healthfirst Commercial |
$170.55
|
| Rate for Payer: Healthfirst Essential Plan |
$383.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.02
|
| Rate for Payer: Healthfirst QHP |
$170.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.91
|
| Rate for Payer: SOMOS Essential |
$127.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.55
|
|
|
PR USE OF ECHO CONTRAST AGENT DURING STRESS ECHO
|
Professional
|
Both
|
$144.27
|
|
|
Service Code
|
HCPCS 93352
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$90.88 |
| Rate for Payer: Cash Price |
$40.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.29
|
| Rate for Payer: Healthfirst Commercial |
$40.39
|
| Rate for Payer: Healthfirst Essential Plan |
$90.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.37
|
| Rate for Payer: Healthfirst QHP |
$40.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.29
|
| Rate for Payer: SOMOS Essential |
$30.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.39
|
|
|
PR USE OPHTHALMIC ENDOSCOPE
|
Professional
|
Both
|
$358.51
|
|
|
Service Code
|
HCPCS 66990
|
| Min. Negotiated Rate |
$68.66 |
| Max. Negotiated Rate |
$220.70 |
| Rate for Payer: Cash Price |
$98.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.57
|
| Rate for Payer: Healthfirst Commercial |
$98.09
|
| Rate for Payer: Healthfirst Essential Plan |
$220.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.19
|
| Rate for Payer: Healthfirst QHP |
$98.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.57
|
| Rate for Payer: SOMOS Essential |
$73.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.09
|
|
|
PR USE VERTICAL ELECTRODES
|
Professional
|
Both
|
$45.99
|
|
|
Service Code
|
HCPCS 92547
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$27.07 |
| Rate for Payer: Cash Price |
$12.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.02
|
| Rate for Payer: Healthfirst Commercial |
$12.03
|
| Rate for Payer: Healthfirst Essential Plan |
$27.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.43
|
| Rate for Payer: Healthfirst QHP |
$12.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.02
|
| Rate for Payer: SOMOS Essential |
$9.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.03
|
|
|
PR UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE
|
Professional
|
Both
|
$2,470.23
|
|
|
Service Code
|
HCPCS 59870
|
| Min. Negotiated Rate |
$451.85 |
| Max. Negotiated Rate |
$1,452.38 |
| Rate for Payer: Cash Price |
$659.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$645.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$580.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$580.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$613.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$645.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$613.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$645.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$645.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$484.12
|
| Rate for Payer: Healthfirst Commercial |
$645.50
|
| Rate for Payer: Healthfirst Essential Plan |
$1,452.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$613.23
|
| Rate for Payer: Healthfirst QHP |
$645.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$451.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$645.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$548.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$451.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$645.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$484.12
|
| Rate for Payer: SOMOS Essential |
$484.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$645.50
|
|
|
PR UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX
|
Professional
|
Both
|
$2,007.99
|
|
|
Service Code
|
HCPCS 58400
|
| Min. Negotiated Rate |
$373.30 |
| Max. Negotiated Rate |
$1,199.90 |
| Rate for Payer: Cash Price |
$545.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$533.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$479.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$479.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$506.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$533.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$506.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$533.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$533.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$399.97
|
| Rate for Payer: Healthfirst Commercial |
$533.29
|
| Rate for Payer: Healthfirst Essential Plan |
$1,199.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$506.63
|
| Rate for Payer: Healthfirst QHP |
$533.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$373.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$533.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$453.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$373.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$533.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$399.97
|
| Rate for Payer: SOMOS Essential |
$399.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$533.29
|
|
|
PR UTERINE SUSP W/WO SHORT LIGAMNTS W/SYMPATHECTOMY
|
Professional
|
Both
|
$3,565.52
|
|
|
Service Code
|
HCPCS 58410
|
| Min. Negotiated Rate |
$661.78 |
| Max. Negotiated Rate |
$2,127.15 |
| Rate for Payer: Cash Price |
$959.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$945.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$850.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$850.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$898.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$945.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$898.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$945.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$945.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$709.05
|
| Rate for Payer: Healthfirst Commercial |
$945.40
|
| Rate for Payer: Healthfirst Essential Plan |
$2,127.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$898.13
|
| Rate for Payer: Healthfirst QHP |
$945.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$661.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$945.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$803.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$661.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$945.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$709.05
|
| Rate for Payer: SOMOS Essential |
$709.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$945.40
|
|
|
PR U-TUBE HEPATICOENTEROSTOMY
|
Professional
|
Both
|
$6,898.36
|
|
|
Service Code
|
HCPCS 47802
|
| Rate for Payer: Cash Price |
$1,836.53
|
|
