|
PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS
|
Professional
|
Both
|
$310.66
|
|
|
Service Code
|
HCPCS 95929 26
|
| Min. Negotiated Rate |
$58.44 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: Amida Care Medicaid |
$157.38
|
| Rate for Payer: Cash Price |
$85.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.62
|
| Rate for Payer: Healthfirst Commercial |
$83.49
|
| Rate for Payer: Healthfirst Essential Plan |
$187.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.32
|
| Rate for Payer: Healthfirst QHP |
$83.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.62
|
| Rate for Payer: SOMOS Essential |
$62.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.49
|
|
|
PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS
|
Professional
|
Both
|
$1,010.45
|
|
|
Service Code
|
HCPCS 95929
|
| Min. Negotiated Rate |
$157.38 |
| Max. Negotiated Rate |
$608.09 |
| Rate for Payer: Amida Care Medicaid |
$157.38
|
| Rate for Payer: Cash Price |
$282.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$270.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$243.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$243.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$256.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$270.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$256.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.69
|
| Rate for Payer: Healthfirst Commercial |
$270.26
|
| Rate for Payer: Healthfirst Essential Plan |
$608.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$256.75
|
| Rate for Payer: Healthfirst QHP |
$270.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$189.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$270.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$229.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$189.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$270.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$202.69
|
| Rate for Payer: SOMOS Essential |
$202.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$270.26
|
|
|
PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS
|
Professional
|
Both
|
$313.39
|
|
|
Service Code
|
HCPCS 95928 26
|
| Min. Negotiated Rate |
$59.14 |
| Max. Negotiated Rate |
$190.10 |
| Rate for Payer: Amida Care Medicaid |
$149.31
|
| Rate for Payer: Cash Price |
$86.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.37
|
| Rate for Payer: Healthfirst Commercial |
$84.49
|
| Rate for Payer: Healthfirst Essential Plan |
$190.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.27
|
| Rate for Payer: Healthfirst QHP |
$84.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.37
|
| Rate for Payer: SOMOS Essential |
$63.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.49
|
|
|
PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS
|
Professional
|
Both
|
$682.54
|
|
|
Service Code
|
HCPCS 95928 TC
|
| Min. Negotiated Rate |
$129.93 |
| Max. Negotiated Rate |
$417.62 |
| Rate for Payer: Amida Care Medicaid |
$149.31
|
| Rate for Payer: Cash Price |
$193.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.21
|
| Rate for Payer: Healthfirst Commercial |
$185.61
|
| Rate for Payer: Healthfirst Essential Plan |
$417.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.33
|
| Rate for Payer: Healthfirst QHP |
$185.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.21
|
| Rate for Payer: SOMOS Essential |
$139.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.61
|
|
|
PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS
|
Professional
|
Both
|
$995.93
|
|
|
Service Code
|
HCPCS 95928
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Amida Care Medicaid |
$149.31
|
| Rate for Payer: Cash Price |
$279.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$270.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$243.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$243.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$256.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$270.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$256.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.58
|
| Rate for Payer: Healthfirst Commercial |
$270.11
|
| Rate for Payer: Healthfirst Essential Plan |
$607.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$256.60
|
| Rate for Payer: Healthfirst QHP |
$270.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$189.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$270.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$229.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$189.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$270.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$202.58
|
| Rate for Payer: SOMOS Essential |
$202.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$270.11
|
|
|
PR CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI
|
Professional
|
Both
|
$2,321.10
|
|
|
Service Code
|
HCPCS 95939
|
| Min. Negotiated Rate |
$214.77 |
| Max. Negotiated Rate |
$1,430.19 |
| Rate for Payer: Amida Care Medicaid |
$214.77
|
| Rate for Payer: Cash Price |
$651.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$635.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$572.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$572.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$603.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$635.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$603.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$635.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$635.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$476.73
|
| Rate for Payer: Healthfirst Commercial |
$635.64
|
| Rate for Payer: Healthfirst Essential Plan |
$1,430.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$603.86
|
| Rate for Payer: Healthfirst QHP |
$635.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$444.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$635.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$540.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$444.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$635.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$476.73
|
| Rate for Payer: SOMOS Essential |
$476.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$635.64
|
|
|
PR CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI
|
Professional
|
Both
|
$467.29
|
|
|
Service Code
|
HCPCS 95939 26
|
| Min. Negotiated Rate |
$89.28 |
| Max. Negotiated Rate |
$286.99 |
| Rate for Payer: Amida Care Medicaid |
$214.77
|
| Rate for Payer: Cash Price |
$128.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.66
|
| Rate for Payer: Healthfirst Commercial |
$127.55
|
| Rate for Payer: Healthfirst Essential Plan |
$286.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.17
|
| Rate for Payer: Healthfirst QHP |
$127.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.66
|
| Rate for Payer: SOMOS Essential |
$95.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.55
|
|
|
PR CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI
|
Professional
|
Both
|
$1,853.81
|
|
|
Service Code
|
HCPCS 95939 TC
|
| Min. Negotiated Rate |
$214.77 |
| Max. Negotiated Rate |
$1,143.18 |
| Rate for Payer: Amida Care Medicaid |
$214.77
|
| Rate for Payer: Cash Price |
$522.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$508.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$457.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$457.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$482.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$508.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$482.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$508.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$508.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$381.06
|
| Rate for Payer: Healthfirst Commercial |
$508.08
|
| Rate for Payer: Healthfirst Essential Plan |
$1,143.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$482.68
|
| Rate for Payer: Healthfirst QHP |
$508.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$355.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$508.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$431.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$355.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$508.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$381.06
|
| Rate for Payer: SOMOS Essential |
$381.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$508.08
|
|
|
PR CURETTAGE POSTPARTUM
|
Professional
|
Both
|
$874.79
|
|
|
Service Code
|
HCPCS 59160
|
| Min. Negotiated Rate |
$158.98 |
| Max. Negotiated Rate |
$511.02 |
| Rate for Payer: Cash Price |
$232.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$227.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$204.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$204.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.34
|
| Rate for Payer: Healthfirst Commercial |
$227.12
|
| Rate for Payer: Healthfirst Essential Plan |
$511.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.76
|
| Rate for Payer: Healthfirst QHP |
$227.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.34
|
| Rate for Payer: SOMOS Essential |
$170.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.12
|
|
|
PR CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX 1ST
|
Professional
|
Both
|
$625.84
|
|
|
Service Code
|
HCPCS 46940
|
| Min. Negotiated Rate |
$117.30 |
| Max. Negotiated Rate |
$377.03 |
| Rate for Payer: Cash Price |
$168.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$167.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$167.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$159.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$167.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.68
|
| Rate for Payer: Healthfirst Commercial |
$167.57
|
| Rate for Payer: Healthfirst Essential Plan |
$377.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$159.19
|
| Rate for Payer: Healthfirst QHP |
$167.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$117.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$167.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$142.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$117.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$167.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$125.68
|
| Rate for Payer: SOMOS Essential |
$125.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$167.57
|
|
|
PR CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ
|
Professional
|
Both
|
$558.57
|
|
|
Service Code
|
HCPCS 46942
|
| Min. Negotiated Rate |
$104.97 |
| Max. Negotiated Rate |
$337.39 |
| Rate for Payer: Cash Price |
$151.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$149.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$149.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.46
|
| Rate for Payer: Healthfirst Commercial |
$149.95
|
| Rate for Payer: Healthfirst Essential Plan |
$337.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.45
|
| Rate for Payer: Healthfirst QHP |
$149.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$149.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.46
|
| Rate for Payer: SOMOS Essential |
$112.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.95
|
|
|
PR CUTANANEOUS APPENDICO-VESICOSTOMY
|
Professional
|
Both
|
$5,238.42
|
|
|
Service Code
|
HCPCS 50845
|
| Min. Negotiated Rate |
$998.01 |
| Max. Negotiated Rate |
$3,207.89 |
| Rate for Payer: Cash Price |
$1,432.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,425.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,283.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,283.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,354.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,425.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,354.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,425.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,425.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,069.30
|
| Rate for Payer: Healthfirst Commercial |
$1,425.73
|
| Rate for Payer: Healthfirst Essential Plan |
$3,207.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,354.44
|
| Rate for Payer: Healthfirst QHP |
$1,425.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$998.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,425.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,211.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$998.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,425.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,069.30
|
| Rate for Payer: SOMOS Essential |
$1,069.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,425.73
|
|
|
PR CUTANEOUS VESICOSTOMY
|
Professional
|
Both
|
$2,993.76
|
|
|
Service Code
|
HCPCS 51980
|
| Min. Negotiated Rate |
$569.68 |
| Max. Negotiated Rate |
$1,831.12 |
| Rate for Payer: Cash Price |
$818.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$732.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$732.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$773.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$773.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$813.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$610.37
|
| Rate for Payer: Healthfirst Commercial |
$813.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,831.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$773.14
|
| Rate for Payer: Healthfirst QHP |
$813.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$569.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$813.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$691.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$569.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$610.37
|
| Rate for Payer: SOMOS Essential |
$610.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.83
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG I&R ONLY
|
Professional
|
Both
|
$54.67
|
|
|
Service Code
|
HCPCS 93018
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$34.24 |
| Rate for Payer: Amida Care Medicaid |
$13.64
|
| Rate for Payer: Cash Price |
$15.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.41
|
| Rate for Payer: Healthfirst Commercial |
$15.22
|
| Rate for Payer: Healthfirst Essential Plan |
$34.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.46
|
| Rate for Payer: Healthfirst QHP |
$15.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.41
|
| Rate for Payer: SOMOS Essential |
$11.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.22
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY
|
Professional
|
Both
|
$156.42
|
|
|
Service Code
|
HCPCS 93017
|
| Min. Negotiated Rate |
$31.57 |
| Max. Negotiated Rate |
$101.47 |
| Rate for Payer: Cash Price |
$44.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.83
|
| Rate for Payer: Healthfirst Commercial |
$45.10
|
| Rate for Payer: Healthfirst Essential Plan |
$101.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.84
|
| Rate for Payer: Healthfirst QHP |
$45.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.83
|
| Rate for Payer: SOMOS Essential |
$33.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.10
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R
|
Professional
|
Both
|
$82.11
|
|
|
Service Code
|
HCPCS 93016
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$50.24 |
| Rate for Payer: Amida Care Medicaid |
$16.67
|
| Rate for Payer: Cash Price |
$22.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.75
|
| Rate for Payer: Healthfirst Commercial |
$22.33
|
| Rate for Payer: Healthfirst Essential Plan |
$50.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.21
|
| Rate for Payer: Healthfirst QHP |
$22.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.75
|
| Rate for Payer: SOMOS Essential |
$16.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.33
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R
|
Professional
|
Both
|
$293.20
|
|
|
Service Code
|
HCPCS 93015
|
| Min. Negotiated Rate |
$57.85 |
| Max. Negotiated Rate |
$185.96 |
| Rate for Payer: Amida Care Medicaid |
$60.60
|
| Rate for Payer: Cash Price |
$82.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.99
|
| Rate for Payer: Healthfirst Commercial |
$82.65
|
| Rate for Payer: Healthfirst Essential Plan |
$185.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.52
|
| Rate for Payer: Healthfirst QHP |
$82.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.99
|
| Rate for Payer: SOMOS Essential |
$61.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.65
|
|
|
PR CYSTECTOMY COMPLETE SEPARATE PROCEDURE
|
Professional
|
Both
|
$6,159.16
|
|
|
Service Code
|
HCPCS 51570
|
| Min. Negotiated Rate |
$1,165.07 |
| Max. Negotiated Rate |
$3,744.86 |
| Rate for Payer: Cash Price |
$1,677.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,664.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,497.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,497.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,581.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,664.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,581.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,664.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,664.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,248.29
|
| Rate for Payer: Healthfirst Commercial |
$1,664.38
|
| Rate for Payer: Healthfirst Essential Plan |
$3,744.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,581.16
|
| Rate for Payer: Healthfirst QHP |
$1,664.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,165.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,664.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,414.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,165.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,664.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,248.29
|
| Rate for Payer: SOMOS Essential |
$1,248.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,664.38
|
|
|
PR CYSTECTOMY PARTIAL COMPLICATED
|
Professional
|
Both
|
$5,273.80
|
|
|
Service Code
|
HCPCS 51555
|
| Min. Negotiated Rate |
$1,002.28 |
| Max. Negotiated Rate |
$3,221.62 |
| Rate for Payer: Cash Price |
$1,441.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,431.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,288.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,288.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,360.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,431.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,360.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,431.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,431.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,073.87
|
| Rate for Payer: Healthfirst Commercial |
$1,431.83
|
| Rate for Payer: Healthfirst Essential Plan |
$3,221.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,360.24
|
| Rate for Payer: Healthfirst QHP |
$1,431.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,002.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,431.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,217.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,002.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,431.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,073.87
|
| Rate for Payer: SOMOS Essential |
$1,073.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,431.83
|
|
|
PR CYSTECTOMY PARTIAL SIMPLE
|
Professional
|
Both
|
$4,066.30
|
|
|
Service Code
|
HCPCS 51550
|
| Min. Negotiated Rate |
$770.46 |
| Max. Negotiated Rate |
$2,476.49 |
| Rate for Payer: Cash Price |
$1,109.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,100.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$990.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$990.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,045.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,100.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,045.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,100.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,100.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$825.50
|
| Rate for Payer: Healthfirst Commercial |
$1,100.66
|
| Rate for Payer: Healthfirst Essential Plan |
$2,476.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,045.63
|
| Rate for Payer: Healthfirst QHP |
$1,100.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$770.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,100.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$935.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$770.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,100.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$825.50
|
| Rate for Payer: SOMOS Essential |
$825.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,100.66
|
|
|
PR CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY
|
Professional
|
Both
|
$7,581.63
|
|
|
Service Code
|
HCPCS 51575
|
| Min. Negotiated Rate |
$1,432.78 |
| Max. Negotiated Rate |
$4,605.37 |
| Rate for Payer: Cash Price |
$2,060.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,046.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,842.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,842.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,944.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,046.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,944.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,046.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,046.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,535.12
|
| Rate for Payer: Healthfirst Commercial |
$2,046.83
|
| Rate for Payer: Healthfirst Essential Plan |
$4,605.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,944.49
|
| Rate for Payer: Healthfirst QHP |
$2,046.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,432.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,046.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,739.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,432.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,046.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,535.12
|
| Rate for Payer: SOMOS Essential |
$1,535.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,046.83
|
|
|
PR CYSTECTOMY W/URETEROSIGMOID BI PELV LYMPH NODES
|
Professional
|
Both
|
$8,769.32
|
|
|
Service Code
|
HCPCS 51585
|
| Min. Negotiated Rate |
$1,664.03 |
| Max. Negotiated Rate |
$5,348.65 |
| Rate for Payer: Cash Price |
$2,392.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,377.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,139.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,139.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,258.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,377.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,258.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,377.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,377.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,782.88
|
| Rate for Payer: Healthfirst Commercial |
$2,377.18
|
| Rate for Payer: Healthfirst Essential Plan |
$5,348.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,258.32
|
| Rate for Payer: Healthfirst QHP |
$2,377.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,664.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,377.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,020.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,664.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,377.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,782.88
|
| Rate for Payer: SOMOS Essential |
$1,782.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,377.18
|
|
|
PR CYSTECTOMY W/URETEROSIGMOIDOSTOMY W/NODES
|
Professional
|
Both
|
$7,886.38
|
|
|
Service Code
|
HCPCS 51580
|
| Min. Negotiated Rate |
$1,497.74 |
| Max. Negotiated Rate |
$4,814.17 |
| Rate for Payer: Cash Price |
$2,153.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,139.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,925.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,925.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,032.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,139.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,032.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,139.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,139.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,604.72
|
| Rate for Payer: Healthfirst Commercial |
$2,139.63
|
| Rate for Payer: Healthfirst Essential Plan |
$4,814.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,032.65
|
| Rate for Payer: Healthfirst QHP |
$2,139.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,497.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,139.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,818.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,497.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,139.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,604.72
|
| Rate for Payer: SOMOS Essential |
$1,604.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,139.63
|
|
|
PR CYSTO BLADDER W/URETERAL CATHETERIZATION
|
Professional
|
Both
|
$547.54
|
|
|
Service Code
|
HCPCS 52005
|
| Min. Negotiated Rate |
$105.57 |
| Max. Negotiated Rate |
$339.32 |
| Rate for Payer: Cash Price |
$151.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.11
|
| Rate for Payer: Healthfirst Commercial |
$150.81
|
| Rate for Payer: Healthfirst Essential Plan |
$339.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.27
|
| Rate for Payer: Healthfirst QHP |
$150.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.11
|
| Rate for Payer: SOMOS Essential |
$113.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.81
|
|
|
PR CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS
|
Professional
|
Both
|
$632.98
|
|
|
Service Code
|
HCPCS 52281
|
| Min. Negotiated Rate |
$120.42 |
| Max. Negotiated Rate |
$387.07 |
| Rate for Payer: Cash Price |
$172.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$163.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$163.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.02
|
| Rate for Payer: Healthfirst Commercial |
$172.03
|
| Rate for Payer: Healthfirst Essential Plan |
$387.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.43
|
| Rate for Payer: Healthfirst QHP |
$172.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$120.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$172.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$120.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.02
|
| Rate for Payer: SOMOS Essential |
$129.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.03
|
|
