|
PR COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV
|
Professional
|
Both
|
$35.53
|
|
|
Service Code
|
HCPCS 92283 26
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.18
|
| Rate for Payer: Healthfirst Commercial |
$9.58
|
| Rate for Payer: Healthfirst Essential Plan |
$21.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.10
|
| Rate for Payer: Healthfirst QHP |
$9.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.18
|
| Rate for Payer: SOMOS Essential |
$7.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.58
|
|
|
PR COLOSTOMY/SKIN LEVEL CECOSTOMY
|
Professional
|
Both
|
$5,333.90
|
|
|
Service Code
|
HCPCS 44320
|
| Min. Negotiated Rate |
$991.67 |
| Max. Negotiated Rate |
$3,187.51 |
| Rate for Payer: Cash Price |
$1,428.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,416.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,275.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,275.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,345.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,416.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,345.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,416.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,416.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,062.50
|
| Rate for Payer: Healthfirst Commercial |
$1,416.67
|
| Rate for Payer: Healthfirst Essential Plan |
$3,187.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,345.84
|
| Rate for Payer: Healthfirst QHP |
$1,416.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$991.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,416.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,204.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$991.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,416.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,062.50
|
| Rate for Payer: SOMOS Essential |
$1,062.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,416.67
|
|
|
PR COLOSTOMY/SKN LVL CECOSTOMY W/MULT BXS SPX
|
Professional
|
Both
|
$4,514.34
|
|
|
Service Code
|
HCPCS 44322
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$2,690.10 |
| Rate for Payer: Cash Price |
$1,208.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,195.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,076.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,076.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,135.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,195.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,135.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,195.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,195.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$896.70
|
| Rate for Payer: Healthfirst Commercial |
$1,195.60
|
| Rate for Payer: Healthfirst Essential Plan |
$2,690.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,135.82
|
| Rate for Payer: Healthfirst QHP |
$1,195.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$836.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,195.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,016.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$836.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,195.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$896.70
|
| Rate for Payer: SOMOS Essential |
$896.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,195.60
|
|
|
PR COLOTOMY EXPLORATION/BIOPSY/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$4,381.90
|
|
|
Service Code
|
HCPCS 44025
|
| Min. Negotiated Rate |
$817.30 |
| Max. Negotiated Rate |
$2,627.03 |
| Rate for Payer: Cash Price |
$1,175.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,167.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,050.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,050.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,109.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,167.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,109.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,167.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,167.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$875.68
|
| Rate for Payer: Healthfirst Commercial |
$1,167.57
|
| Rate for Payer: Healthfirst Essential Plan |
$2,627.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,109.19
|
| Rate for Payer: Healthfirst QHP |
$1,167.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$817.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,167.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$992.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$817.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,167.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$875.68
|
| Rate for Payer: SOMOS Essential |
$875.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,167.57
|
|
|
PR COLPOCENTESIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$345.42
|
|
|
Service Code
|
HCPCS 57020
|
| Min. Negotiated Rate |
$63.83 |
| Max. Negotiated Rate |
$205.18 |
| Rate for Payer: Cash Price |
$92.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.39
|
| Rate for Payer: Healthfirst Commercial |
$91.19
|
| Rate for Payer: Healthfirst Essential Plan |
$205.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.63
|
| Rate for Payer: Healthfirst QHP |
$91.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.39
|
| Rate for Payer: SOMOS Essential |
$68.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.19
|
|
|
PR COLPOCLEISIS LE FORT TYPE
|
Professional
|
Both
|
$2,309.86
|
|
|
Service Code
|
HCPCS 57120
|
| Min. Negotiated Rate |
$430.79 |
| Max. Negotiated Rate |
$1,384.67 |
| Rate for Payer: Cash Price |
$625.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$615.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$553.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$553.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$584.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$615.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$584.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$615.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$615.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$461.56
|
| Rate for Payer: Healthfirst Commercial |
$615.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,384.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$584.64
|
| Rate for Payer: Healthfirst QHP |
$615.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$430.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$615.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$523.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$430.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$615.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$461.56
|
| Rate for Payer: SOMOS Essential |
$461.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$615.41
|
|
|
PR COLPOPERINEORRHAPHY SUTURE INJ VAGINA&/PERINEU
|
Professional
|
Both
|
$1,713.08
|
|
|
Service Code
|
HCPCS 57210
|
| Min. Negotiated Rate |
$319.61 |
| Max. Negotiated Rate |
$1,027.31 |
| Rate for Payer: Cash Price |
$465.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$456.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$410.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$410.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$433.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$456.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$433.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$456.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$456.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$342.44
|
| Rate for Payer: Healthfirst Commercial |
$456.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,027.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$433.75
|
| Rate for Payer: Healthfirst QHP |
$456.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$319.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$456.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$388.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$319.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$456.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$342.44
|
| Rate for Payer: SOMOS Essential |
$342.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$456.58
|
|
|
PR COLPOPEXY ABDOMINAL APPROACH
|
Professional
|
Both
|
$4,177.46
|
|
|
Service Code
|
HCPCS 57280
|
| Min. Negotiated Rate |
$779.63 |
| Max. Negotiated Rate |
$2,505.96 |
| Rate for Payer: Cash Price |
$1,128.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,113.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,002.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,002.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,058.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,113.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,058.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,113.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,113.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$835.32
|
| Rate for Payer: Healthfirst Commercial |
$1,113.76
|
| Rate for Payer: Healthfirst Essential Plan |
$2,505.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,058.07
|
| Rate for Payer: Healthfirst QHP |
$1,113.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$779.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,113.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$946.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$779.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,113.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$835.32
|
| Rate for Payer: SOMOS Essential |
$835.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,113.76
|
|
|
PR COLPOPEXY VAGINAL EXTRAPERITONEAL APPROACH
|
Professional
|
Both
|
$3,010.14
|
|
|
Service Code
|
HCPCS 57282
|
| Min. Negotiated Rate |
$561.03 |
| Max. Negotiated Rate |
$1,803.31 |
| Rate for Payer: Cash Price |
$813.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$801.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$721.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$721.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$761.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$801.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$761.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$801.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$801.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$601.10
|
| Rate for Payer: Healthfirst Commercial |
$801.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,803.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$761.40
|
| Rate for Payer: Healthfirst QHP |
$801.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$561.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$801.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$681.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$561.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$801.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$601.10
|
| Rate for Payer: SOMOS Essential |
$601.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$801.47
|
|
|
PR COLPOPEXY VAGINAL INTRAPERITONEAL APPROACH
|
Professional
|
Both
|
$3,047.17
|
|
|
Service Code
|
HCPCS 57283
|
| Min. Negotiated Rate |
$567.17 |
| Max. Negotiated Rate |
$1,823.04 |
| Rate for Payer: Cash Price |
$820.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$810.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$729.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$729.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$769.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$810.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$769.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$810.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$810.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$607.68
|
| Rate for Payer: Healthfirst Commercial |
$810.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,823.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$769.73
|
| Rate for Payer: Healthfirst QHP |
$810.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$567.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$810.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$688.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$567.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$810.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$607.68
|
| Rate for Payer: SOMOS Essential |
$607.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$810.24
|
|
|
PR COLPORRHAPHY SUTURE INJURY VAGINA
|
Professional
|
Both
|
$1,446.34
|
|
|
Service Code
|
HCPCS 57200
|
| Min. Negotiated Rate |
$271.04 |
| Max. Negotiated Rate |
$871.20 |
| Rate for Payer: Cash Price |
$394.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$387.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$348.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$348.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$367.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$387.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$367.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$387.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$387.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$290.40
|
| Rate for Payer: Healthfirst Commercial |
$387.20
|
| Rate for Payer: Healthfirst Essential Plan |
$871.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$367.84
|
| Rate for Payer: Healthfirst QHP |
$387.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$271.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$387.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$329.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$271.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$387.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$290.40
|
| Rate for Payer: SOMOS Essential |
$290.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$387.20
|
|
|
PR COLPOSCOPY CERVIX BX CERVIX & ENDOCRV CURRETAGE
|
Professional
|
Both
|
$574.18
|
|
|
Service Code
|
HCPCS 57454
|
| Min. Negotiated Rate |
$108.38 |
| Max. Negotiated Rate |
$348.37 |
| Rate for Payer: Cash Price |
$156.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.12
|
| Rate for Payer: Healthfirst Commercial |
$154.83
|
| Rate for Payer: Healthfirst Essential Plan |
$348.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.09
|
| Rate for Payer: Healthfirst QHP |
$154.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.12
|
| Rate for Payer: SOMOS Essential |
$116.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.83
|
|
|
PR COLPOSCOPY CERVIX ENDOCERVICAL CURETTAGE
|
Professional
|
Both
|
$437.43
|
|
|
Service Code
|
HCPCS 57456
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$259.72 |
| Rate for Payer: Cash Price |
$118.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$115.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.57
|
| Rate for Payer: Healthfirst Commercial |
$115.43
|
| Rate for Payer: Healthfirst Essential Plan |
$259.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.66
|
| Rate for Payer: Healthfirst QHP |
$115.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$115.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.57
|
| Rate for Payer: SOMOS Essential |
$86.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.43
|
|
|
PR COLPOSCOPY CERVIX UPPER/ADJACENT VAGINA
|
Professional
|
Both
|
$394.28
|
|
|
Service Code
|
HCPCS 57452
|
| Min. Negotiated Rate |
$73.72 |
| Max. Negotiated Rate |
$236.97 |
| Rate for Payer: Cash Price |
$106.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$94.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$94.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.99
|
| Rate for Payer: Healthfirst Commercial |
$105.32
|
| Rate for Payer: Healthfirst Essential Plan |
$236.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.05
|
| Rate for Payer: Healthfirst QHP |
$105.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$105.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$89.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.99
|
| Rate for Payer: SOMOS Essential |
$78.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.32
|
|
|
PR COLPOSCOPY CERVIX UPPR/ADJCNT VAGINA W/CERVIX BX
|
Professional
|
Both
|
$467.74
|
|
|
Service Code
|
HCPCS 57455
|
| Min. Negotiated Rate |
$88.24 |
| Max. Negotiated Rate |
$283.63 |
| Rate for Payer: Cash Price |
$126.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.55
|
| Rate for Payer: Healthfirst Commercial |
$126.06
|
| Rate for Payer: Healthfirst Essential Plan |
$283.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.76
|
| Rate for Payer: Healthfirst QHP |
$126.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.55
|
| Rate for Payer: SOMOS Essential |
$94.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.06
|
|
|
PR COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX
|
Professional
|
Both
|
$794.15
|
|
|
Service Code
|
HCPCS 57461
|
| Min. Negotiated Rate |
$148.29 |
| Max. Negotiated Rate |
$476.66 |
| Rate for Payer: Cash Price |
$213.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$211.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$190.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$190.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$201.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$211.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$201.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$211.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$211.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.89
|
| Rate for Payer: Healthfirst Commercial |
$211.85
|
| Rate for Payer: Healthfirst Essential Plan |
$476.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.26
|
| Rate for Payer: Healthfirst QHP |
$211.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$211.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$180.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$211.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$158.89
|
| Rate for Payer: SOMOS Essential |
$158.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$211.85
|
|
|
PR COLPOSCOPY CERVIX VAG LOOP ELTRD BX CERVIX
|
Professional
|
Both
|
$690.20
|
|
|
Service Code
|
HCPCS 57460
|
| Min. Negotiated Rate |
$129.93 |
| Max. Negotiated Rate |
$417.64 |
| Rate for Payer: Cash Price |
$186.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.22
|
| Rate for Payer: Healthfirst Commercial |
$185.62
|
| Rate for Payer: Healthfirst Essential Plan |
$417.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.34
|
| Rate for Payer: Healthfirst QHP |
$185.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.22
|
| Rate for Payer: SOMOS Essential |
$139.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.62
|
|
|
PR COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT
|
Professional
|
Both
|
$385.25
|
|
|
Service Code
|
HCPCS 57420
|
| Min. Negotiated Rate |
$73.09 |
| Max. Negotiated Rate |
$234.92 |
| Rate for Payer: Cash Price |
$104.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.31
|
| Rate for Payer: Healthfirst Commercial |
$104.41
|
| Rate for Payer: Healthfirst Essential Plan |
$234.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$99.19
|
| Rate for Payer: Healthfirst QHP |
$104.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.31
|
| Rate for Payer: SOMOS Essential |
$78.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.41
|
|
|
PR COLPOSCOPY ENTIRE VAGINA W/VAGINA/CERVIX BX
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 57421
|
| Min. Negotiated Rate |
$99.27 |
| Max. Negotiated Rate |
$319.10 |
| Rate for Payer: Cash Price |
$142.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.36
|
| Rate for Payer: Healthfirst Commercial |
$141.82
|
| Rate for Payer: Healthfirst Essential Plan |
$319.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.73
|
| Rate for Payer: Healthfirst QHP |
$141.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$120.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.36
|
| Rate for Payer: SOMOS Essential |
$106.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.82
|
|
|
PR COLPOSCOPY VULVA
|
Professional
|
Both
|
$366.98
|
|
|
Service Code
|
HCPCS 56820
|
| Min. Negotiated Rate |
$68.02 |
| Max. Negotiated Rate |
$218.63 |
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.88
|
| Rate for Payer: Healthfirst Commercial |
$97.17
|
| Rate for Payer: Healthfirst Essential Plan |
$218.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.31
|
| Rate for Payer: Healthfirst QHP |
$97.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.88
|
| Rate for Payer: SOMOS Essential |
$72.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.17
|
|
|
PR COLPOSCOPY VULVA W/BIOPSY
|
Professional
|
Both
|
$493.40
|
|
|
Service Code
|
HCPCS 56821
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$295.79 |
| Rate for Payer: Cash Price |
$132.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.59
|
| Rate for Payer: Healthfirst Commercial |
$131.46
|
| Rate for Payer: Healthfirst Essential Plan |
$295.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.89
|
| Rate for Payer: Healthfirst QHP |
$131.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.59
|
| Rate for Payer: SOMOS Essential |
$98.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.46
|
|
|
PR COLPOTOMY W/DRAINAGE PELVIC ABSCESS
|
Professional
|
Both
|
$2,002.49
|
|
|
Service Code
|
HCPCS 57010
|
| Min. Negotiated Rate |
$372.84 |
| Max. Negotiated Rate |
$1,198.42 |
| Rate for Payer: Cash Price |
$542.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$532.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$479.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$479.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$506.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$532.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$506.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$532.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$399.47
|
| Rate for Payer: Healthfirst Commercial |
$532.63
|
| Rate for Payer: Healthfirst Essential Plan |
$1,198.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$506.00
|
| Rate for Payer: Healthfirst QHP |
$532.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$372.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$532.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$452.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$372.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$532.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$399.47
|
| Rate for Payer: SOMOS Essential |
$399.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$532.63
|
|
|
PR COLPOTOMY W/EXPLORATION
|
Professional
|
Both
|
$884.49
|
|
|
Service Code
|
HCPCS 57000
|
| Min. Negotiated Rate |
$164.29 |
| Max. Negotiated Rate |
$528.08 |
| Rate for Payer: Cash Price |
$238.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$234.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$211.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$211.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$222.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$234.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$222.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$234.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$234.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$176.03
|
| Rate for Payer: Healthfirst Commercial |
$234.70
|
| Rate for Payer: Healthfirst Essential Plan |
$528.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$222.97
|
| Rate for Payer: Healthfirst QHP |
$234.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$164.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$234.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$199.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$164.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$234.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$176.03
|
| Rate for Payer: SOMOS Essential |
$176.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$234.70
|
|
|
PR COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD
|
Professional
|
Both
|
$1,076.25
|
|
|
Service Code
|
HCPCS 45382
|
| Min. Negotiated Rate |
$202.63 |
| Max. Negotiated Rate |
$651.31 |
| Rate for Payer: Cash Price |
$291.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$289.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$260.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$260.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$275.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$289.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$289.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$289.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$217.10
|
| Rate for Payer: Healthfirst Commercial |
$289.47
|
| Rate for Payer: Healthfirst Essential Plan |
$651.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.00
|
| Rate for Payer: Healthfirst QHP |
$289.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$202.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$289.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$246.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$202.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$289.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$217.10
|
| Rate for Payer: SOMOS Essential |
$217.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$289.47
|
|
|
PR COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT
|
Professional
|
Both
|
$883.96
|
|
|
Service Code
|
HCPCS 45386
|
| Min. Negotiated Rate |
$167.43 |
| Max. Negotiated Rate |
$538.18 |
| Rate for Payer: Cash Price |
$240.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$239.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$215.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$215.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$227.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$239.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$227.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$239.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$239.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.39
|
| Rate for Payer: Healthfirst Commercial |
$239.19
|
| Rate for Payer: Healthfirst Essential Plan |
$538.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$227.23
|
| Rate for Payer: Healthfirst QHP |
$239.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$167.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$239.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$203.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$167.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$239.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$179.39
|
| Rate for Payer: SOMOS Essential |
$179.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$239.19
|
|
