|
PR UVULECTOMY EXCISION UVULA
|
Professional
|
Both
|
$702.52
|
|
|
Service Code
|
HCPCS 42140
|
| Min. Negotiated Rate |
$133.98 |
| Max. Negotiated Rate |
$430.65 |
| Rate for Payer: Cash Price |
$192.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$181.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.55
|
| Rate for Payer: Healthfirst Commercial |
$191.40
|
| Rate for Payer: Healthfirst Essential Plan |
$430.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$181.83
|
| Rate for Payer: Healthfirst QHP |
$191.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$162.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.55
|
| Rate for Payer: SOMOS Essential |
$143.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.40
|
|
|
PR VAG HYST > 250 GM RMVL TUBE&/OVARY
|
Professional
|
Both
|
$5,429.17
|
|
|
Service Code
|
HCPCS 58291
|
| Min. Negotiated Rate |
$1,006.54 |
| Max. Negotiated Rate |
$3,235.30 |
| Rate for Payer: Cash Price |
$1,459.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,437.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,294.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,294.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,366.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,437.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,366.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,437.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,437.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,078.43
|
| Rate for Payer: Healthfirst Commercial |
$1,437.91
|
| Rate for Payer: Healthfirst Essential Plan |
$3,235.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,366.01
|
| Rate for Payer: Healthfirst QHP |
$1,437.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,006.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,437.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,222.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,006.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,437.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,078.43
|
| Rate for Payer: SOMOS Essential |
$1,078.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,437.91
|
|
|
PR VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR ENTRCLE
|
Professional
|
Both
|
$5,722.82
|
|
|
Service Code
|
HCPCS 58292
|
| Min. Negotiated Rate |
$1,059.88 |
| Max. Negotiated Rate |
$3,406.77 |
| Rate for Payer: Cash Price |
$1,537.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,514.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,362.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,362.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,438.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,514.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,438.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,514.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,514.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,135.59
|
| Rate for Payer: Healthfirst Commercial |
$1,514.12
|
| Rate for Payer: Healthfirst Essential Plan |
$3,406.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,438.41
|
| Rate for Payer: Healthfirst QHP |
$1,514.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,059.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,514.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,287.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,059.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,514.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,135.59
|
| Rate for Payer: SOMOS Essential |
$1,135.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,514.12
|
|
|
PR VAG HYST 250 GM/< W/COLPO-URTCSTOPEXY
|
Professional
|
Both
|
$4,671.03
|
|
|
Service Code
|
HCPCS 58267
|
| Min. Negotiated Rate |
$867.29 |
| Max. Negotiated Rate |
$2,787.70 |
| Rate for Payer: Cash Price |
$1,257.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,238.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,115.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,115.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,177.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,238.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,177.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,238.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,238.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$929.24
|
| Rate for Payer: Healthfirst Commercial |
$1,238.98
|
| Rate for Payer: Healthfirst Essential Plan |
$2,787.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,177.03
|
| Rate for Payer: Healthfirst QHP |
$1,238.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$867.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,238.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,053.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$867.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,238.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$929.24
|
| Rate for Payer: SOMOS Essential |
$929.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,238.98
|
|
|
PR VAG HYST 250 GM/< W/RMVL TUBE&/OVARY
|
Professional
|
Both
|
$4,036.52
|
|
|
Service Code
|
HCPCS 58262
|
| Min. Negotiated Rate |
$752.07 |
| Max. Negotiated Rate |
$2,417.38 |
| Rate for Payer: Cash Price |
$1,089.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,074.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$966.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$966.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,020.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,074.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,020.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,074.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,074.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$805.79
|
| Rate for Payer: Healthfirst Commercial |
$1,074.39
|
| Rate for Payer: Healthfirst Essential Plan |
$2,417.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,020.67
|
| Rate for Payer: Healthfirst QHP |
$1,074.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$752.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,074.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$913.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$752.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,074.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$805.79
|
| Rate for Payer: SOMOS Essential |
$805.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,074.39
|
|
|
PR VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL
|
Professional
|
Both
|
$4,332.90
|
|
|
Service Code
|
HCPCS 58263
|
| Min. Negotiated Rate |
$807.31 |
| Max. Negotiated Rate |
$2,594.93 |
| Rate for Payer: Cash Price |
$1,167.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,153.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,037.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,037.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,095.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,153.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,095.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,153.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,153.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$864.98
|
| Rate for Payer: Healthfirst Commercial |
$1,153.30
|
| Rate for Payer: Healthfirst Essential Plan |
$2,594.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,095.63
|
| Rate for Payer: Healthfirst QHP |
$1,153.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$807.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,153.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$980.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$807.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,153.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$864.98
|
| Rate for Payer: SOMOS Essential |
$864.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,153.30
|
|
|
PR VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE
|
Professional
|
Both
|
$4,628.47
|
|
|
Service Code
|
HCPCS 58280
|
| Min. Negotiated Rate |
$858.47 |
| Max. Negotiated Rate |
$2,759.38 |
| Rate for Payer: Cash Price |
$1,246.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,226.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,103.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,103.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,165.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,226.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,165.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,226.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,226.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$919.79
|
| Rate for Payer: Healthfirst Commercial |
$1,226.39
|
| Rate for Payer: Healthfirst Essential Plan |
$2,759.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,165.07
|
| Rate for Payer: Healthfirst QHP |
$1,226.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$858.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,226.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,042.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$858.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,226.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$919.79
|
| Rate for Payer: SOMOS Essential |
$919.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,226.39
|
|
|
PR VAGINAL DELIVERY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$4,225.48
|
|
|
Service Code
|
HCPCS 59612
|
| Min. Negotiated Rate |
$768.32 |
| Max. Negotiated Rate |
$2,469.60 |
| Rate for Payer: Cash Price |
$1,112.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,097.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$987.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$987.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,042.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,097.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,042.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,097.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,097.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$823.20
|
| Rate for Payer: Healthfirst Commercial |
$1,097.60
|
| Rate for Payer: Healthfirst Essential Plan |
$2,469.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,042.72
|
| Rate for Payer: Healthfirst QHP |
$1,097.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$768.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,097.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$932.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$768.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,097.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$823.20
|
| Rate for Payer: SOMOS Essential |
$823.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,097.60
|
|
|
PR VAGINAL DELIVERY ONLY
|
Professional
|
Both
|
$3,675.77
|
|
|
Service Code
|
HCPCS 59409
|
| Min. Negotiated Rate |
$670.05 |
| Max. Negotiated Rate |
$2,153.72 |
| Rate for Payer: Cash Price |
$970.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$957.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$861.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$861.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$909.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$957.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$909.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$957.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$957.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$717.91
|
| Rate for Payer: Healthfirst Commercial |
$957.21
|
| Rate for Payer: Healthfirst Essential Plan |
$2,153.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$909.35
|
| Rate for Payer: Healthfirst QHP |
$957.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$670.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$957.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$813.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$670.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$957.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$717.91
|
| Rate for Payer: SOMOS Essential |
$717.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$957.21
|
|
|
PR VAGINAL DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$4,864.86
|
|
|
Service Code
|
HCPCS 59410
|
| Min. Negotiated Rate |
$907.87 |
| Max. Negotiated Rate |
$2,918.16 |
| Rate for Payer: Cash Price |
$1,314.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,296.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,167.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,167.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,232.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,296.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,232.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,296.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,296.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$972.72
|
| Rate for Payer: Healthfirst Commercial |
$1,296.96
|
| Rate for Payer: Healthfirst Essential Plan |
$2,918.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,232.11
|
| Rate for Payer: Healthfirst QHP |
$1,296.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$907.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,296.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,102.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$907.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,296.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$972.72
|
| Rate for Payer: SOMOS Essential |
$972.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,296.96
|
|
|
PR VAGINAL DELIVERY & POSTPARTUM CARE VBAC
|
Professional
|
Both
|
$5,338.69
|
|
|
Service Code
|
HCPCS 59614
|
| Min. Negotiated Rate |
$992.49 |
| Max. Negotiated Rate |
$3,190.14 |
| Rate for Payer: Cash Price |
$1,436.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,417.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,276.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,276.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,346.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,417.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,346.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,417.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,417.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,063.38
|
| Rate for Payer: Healthfirst Commercial |
$1,417.84
|
| Rate for Payer: Healthfirst Essential Plan |
$3,190.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,346.95
|
| Rate for Payer: Healthfirst QHP |
$1,417.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$992.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,417.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,205.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$992.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,417.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,063.38
|
| Rate for Payer: SOMOS Essential |
$1,063.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,417.84
|
|
|
PR VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE
|
Professional
|
Both
|
$5,314.65
|
|
|
Service Code
|
HCPCS 58294
|
| Min. Negotiated Rate |
$985.35 |
| Max. Negotiated Rate |
$3,167.19 |
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,407.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,266.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,266.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,337.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,407.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,337.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,407.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,407.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,055.73
|
| Rate for Payer: Healthfirst Commercial |
$1,407.64
|
| Rate for Payer: Healthfirst Essential Plan |
$3,167.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,337.26
|
| Rate for Payer: Healthfirst QHP |
$1,407.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$985.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,407.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,196.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$985.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,407.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,055.73
|
| Rate for Payer: SOMOS Essential |
$1,055.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,407.64
|
|
|
PR VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE
|
Professional
|
Both
|
$3,905.58
|
|
|
Service Code
|
HCPCS 58270
|
| Min. Negotiated Rate |
$725.09 |
| Max. Negotiated Rate |
$2,330.64 |
| Rate for Payer: Cash Price |
$1,050.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,035.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$932.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$932.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$984.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,035.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$984.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,035.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,035.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$776.88
|
| Rate for Payer: Healthfirst Commercial |
$1,035.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,330.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$984.05
|
| Rate for Payer: Healthfirst QHP |
$1,035.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$725.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,035.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$880.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$725.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,035.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$776.88
|
| Rate for Payer: SOMOS Essential |
$776.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,035.84
|
|
|
PR VAGINAL HYSTERECTOMY RADICAL SCHAUTA OPERATION
|
Professional
|
Both
|
$6,179.39
|
|
|
Service Code
|
HCPCS 58285
|
| Min. Negotiated Rate |
$1,157.34 |
| Max. Negotiated Rate |
$3,720.01 |
| Rate for Payer: Cash Price |
$1,674.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,653.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,488.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,488.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,570.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,653.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,570.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,653.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,653.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,240.01
|
| Rate for Payer: Healthfirst Commercial |
$1,653.34
|
| Rate for Payer: Healthfirst Essential Plan |
$3,720.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,570.67
|
| Rate for Payer: Healthfirst QHP |
$1,653.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,157.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,653.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,405.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,157.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,653.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,240.01
|
| Rate for Payer: SOMOS Essential |
$1,240.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,653.34
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS > 250 GM
|
Professional
|
Both
|
$5,023.69
|
|
|
Service Code
|
HCPCS 58290
|
| Min. Negotiated Rate |
$932.51 |
| Max. Negotiated Rate |
$2,997.36 |
| Rate for Payer: Cash Price |
$1,351.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,332.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,198.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,198.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,265.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,332.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,265.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,332.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,332.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$999.12
|
| Rate for Payer: Healthfirst Commercial |
$1,332.16
|
| Rate for Payer: Healthfirst Essential Plan |
$2,997.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,265.55
|
| Rate for Payer: Healthfirst QHP |
$1,332.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$932.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,332.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,132.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$932.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,332.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$999.12
|
| Rate for Payer: SOMOS Essential |
$999.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,332.16
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$3,661.98
|
|
|
Service Code
|
HCPCS 58260
|
| Min. Negotiated Rate |
$680.76 |
| Max. Negotiated Rate |
$2,188.15 |
| Rate for Payer: Cash Price |
$987.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$972.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$875.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$875.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$923.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$972.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$923.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$972.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$972.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$729.38
|
| Rate for Payer: Healthfirst Commercial |
$972.51
|
| Rate for Payer: Healthfirst Essential Plan |
$2,188.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$923.88
|
| Rate for Payer: Healthfirst QHP |
$972.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$680.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$972.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$826.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$680.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$972.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$729.38
|
| Rate for Payer: SOMOS Essential |
$729.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$972.51
|
|
|
PR VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY
|
Professional
|
Both
|
$4,297.86
|
|
|
Service Code
|
HCPCS 58275
|
| Min. Negotiated Rate |
$804.99 |
| Max. Negotiated Rate |
$2,587.48 |
| Rate for Payer: Cash Price |
$1,162.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,149.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,034.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,034.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,092.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,149.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,092.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,149.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,149.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$862.49
|
| Rate for Payer: Healthfirst Commercial |
$1,149.99
|
| Rate for Payer: Healthfirst Essential Plan |
$2,587.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,092.49
|
| Rate for Payer: Healthfirst QHP |
$1,149.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$804.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,149.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$977.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$804.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,149.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$862.49
|
| Rate for Payer: SOMOS Essential |
$862.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,149.99
|
|
|
PR VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$3,934.14
|
|
|
Service Code
|
HCPCS 57110
|
| Min. Negotiated Rate |
$730.58 |
| Max. Negotiated Rate |
$2,348.28 |
| Rate for Payer: Cash Price |
$1,060.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,043.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$939.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$939.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$991.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,043.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$991.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,043.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,043.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$782.76
|
| Rate for Payer: Healthfirst Commercial |
$1,043.68
|
| Rate for Payer: Healthfirst Essential Plan |
$2,348.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$991.50
|
| Rate for Payer: Healthfirst QHP |
$1,043.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$730.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,043.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$887.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$730.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,043.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$782.76
|
| Rate for Payer: SOMOS Essential |
$782.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,043.68
|
|
|
PR VAGINECTOMY COMPL RMVL VAG WALL & PARAVAG TISS
|
Professional
|
Both
|
$7,512.89
|
|
|
Service Code
|
HCPCS 57111
|
| Min. Negotiated Rate |
$1,410.70 |
| Max. Negotiated Rate |
$4,534.40 |
| Rate for Payer: Cash Price |
$2,039.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,015.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,813.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,813.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,914.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,015.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,914.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,015.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,015.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,511.47
|
| Rate for Payer: Healthfirst Commercial |
$2,015.29
|
| Rate for Payer: Healthfirst Essential Plan |
$4,534.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,914.53
|
| Rate for Payer: Healthfirst QHP |
$2,015.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,410.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,015.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,713.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,410.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,015.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,511.47
|
| Rate for Payer: SOMOS Essential |
$1,511.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,015.29
|
|
|
PR VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$2,337.20
|
|
|
Service Code
|
HCPCS 57106
|
| Min. Negotiated Rate |
$437.86 |
| Max. Negotiated Rate |
$1,407.42 |
| Rate for Payer: Cash Price |
$635.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$625.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$562.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$562.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$594.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$625.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$594.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$625.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$625.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$469.14
|
| Rate for Payer: Healthfirst Commercial |
$625.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,407.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$594.24
|
| Rate for Payer: Healthfirst QHP |
$625.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$437.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$625.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$531.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$437.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$625.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$469.14
|
| Rate for Payer: SOMOS Essential |
$469.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$625.52
|
|
|
PR VAGINECTOMY PRTL RMVL VAG WALL & PARAVAGINAL T
|
Professional
|
Both
|
$6,316.70
|
|
|
Service Code
|
HCPCS 57107
|
| Min. Negotiated Rate |
$1,183.37 |
| Max. Negotiated Rate |
$3,803.69 |
| Rate for Payer: Cash Price |
$1,712.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,690.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,521.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,521.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,606.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,690.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,606.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,690.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,690.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,267.90
|
| Rate for Payer: Healthfirst Commercial |
$1,690.53
|
| Rate for Payer: Healthfirst Essential Plan |
$3,803.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,606.00
|
| Rate for Payer: Healthfirst QHP |
$1,690.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,183.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,690.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,436.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,183.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,690.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,267.90
|
| Rate for Payer: SOMOS Essential |
$1,267.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,690.53
|
|
|
PR VAGINOPLASTY INTERSEX STATE
|
Professional
|
Both
|
$5,139.72
|
|
|
Service Code
|
HCPCS 57335
|
| Min. Negotiated Rate |
$953.50 |
| Max. Negotiated Rate |
$3,064.84 |
| Rate for Payer: Cash Price |
$1,384.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,362.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,225.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,225.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,294.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,362.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,294.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,362.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,362.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,021.61
|
| Rate for Payer: Healthfirst Commercial |
$1,362.15
|
| Rate for Payer: Healthfirst Essential Plan |
$3,064.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,294.04
|
| Rate for Payer: Healthfirst QHP |
$1,362.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$953.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,362.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,157.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$953.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,362.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,021.61
|
| Rate for Payer: SOMOS Essential |
$1,021.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,362.15
|
|
|
PR VAGNC PRTL RMVL VAG WALL W/BI TOT PEL LMPHADEC
|
Professional
|
Both
|
$7,512.89
|
|
|
Service Code
|
HCPCS 57109
|
| Min. Negotiated Rate |
$1,410.70 |
| Max. Negotiated Rate |
$4,534.40 |
| Rate for Payer: Cash Price |
$2,039.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,015.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,813.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,813.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,914.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,015.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,914.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,015.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,015.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,511.47
|
| Rate for Payer: Healthfirst Commercial |
$2,015.29
|
| Rate for Payer: Healthfirst Essential Plan |
$4,534.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,914.53
|
| Rate for Payer: Healthfirst QHP |
$2,015.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,410.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,015.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,713.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,410.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,015.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,511.47
|
| Rate for Payer: SOMOS Essential |
$1,511.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,015.29
|
|
|
PR VAGOTOMY PFRMD W/PRTL DSTL GSTRCT
|
Professional
|
Both
|
$508.24
|
|
|
Service Code
|
HCPCS 43635
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$300.11 |
| Rate for Payer: Cash Price |
$134.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$133.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$133.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.03
|
| Rate for Payer: Healthfirst Commercial |
$133.38
|
| Rate for Payer: Healthfirst Essential Plan |
$300.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.71
|
| Rate for Payer: Healthfirst QHP |
$133.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$133.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$133.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.03
|
| Rate for Payer: SOMOS Essential |
$100.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.38
|
|
|
PR VALVECTOMY TRICUSPID VALVE W/CARDIOPULMONARY BYP
|
Professional
|
Both
|
$10,556.32
|
|
|
Service Code
|
HCPCS 33460
|
| Min. Negotiated Rate |
$1,941.66 |
| Max. Negotiated Rate |
$6,241.05 |
| Rate for Payer: Cash Price |
$2,801.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,773.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,496.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,496.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,635.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,773.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,635.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,773.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,773.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,080.35
|
| Rate for Payer: Healthfirst Commercial |
$2,773.80
|
| Rate for Payer: Healthfirst Essential Plan |
$6,241.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,635.11
|
| Rate for Payer: Healthfirst QHP |
$2,773.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,941.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,773.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,357.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,941.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,773.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,080.35
|
| Rate for Payer: SOMOS Essential |
$2,080.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,773.80
|
|
