|
PR URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS
|
Professional
|
Both
|
$5,224.24
|
|
|
Service Code
|
HCPCS 50715
|
| Min. Negotiated Rate |
$985.92 |
| Max. Negotiated Rate |
$3,169.03 |
| Rate for Payer: Cash Price |
$1,416.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,408.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,267.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,267.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,338.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,408.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,338.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,408.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,408.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,056.35
|
| Rate for Payer: Healthfirst Commercial |
$1,408.46
|
| Rate for Payer: Healthfirst Essential Plan |
$3,169.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,338.04
|
| Rate for Payer: Healthfirst QHP |
$1,408.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$985.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,408.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,197.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$985.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,408.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,056.35
|
| Rate for Payer: SOMOS Essential |
$1,056.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,408.46
|
|
|
PR URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER
|
Professional
|
Both
|
$4,706.21
|
|
|
Service Code
|
HCPCS 50780
|
| Min. Negotiated Rate |
$893.43 |
| Max. Negotiated Rate |
$2,871.74 |
| Rate for Payer: Cash Price |
$1,284.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,276.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,148.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,148.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,212.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,276.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,212.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,276.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,276.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$957.25
|
| Rate for Payer: Healthfirst Commercial |
$1,276.33
|
| Rate for Payer: Healthfirst Essential Plan |
$2,871.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,212.51
|
| Rate for Payer: Healthfirst QHP |
$1,276.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$893.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,276.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,084.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$893.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,276.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$957.25
|
| Rate for Payer: SOMOS Essential |
$957.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,276.33
|
|
|
PR URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR
|
Professional
|
Both
|
$4,484.06
|
|
|
Service Code
|
HCPCS 50782
|
| Min. Negotiated Rate |
$852.59 |
| Max. Negotiated Rate |
$2,740.45 |
| Rate for Payer: Cash Price |
$1,224.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,217.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,096.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,096.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,157.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,217.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,157.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,217.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,217.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$913.49
|
| Rate for Payer: Healthfirst Commercial |
$1,217.98
|
| Rate for Payer: Healthfirst Essential Plan |
$2,740.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,157.08
|
| Rate for Payer: Healthfirst QHP |
$1,217.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$852.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,217.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,035.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$852.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,217.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$913.49
|
| Rate for Payer: SOMOS Essential |
$913.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,217.98
|
|
|
PR URETERONEOCYSTOSTOMY W/URETERAL TAILORING
|
Professional
|
Both
|
$4,698.93
|
|
|
Service Code
|
HCPCS 50783
|
| Min. Negotiated Rate |
$892.32 |
| Max. Negotiated Rate |
$2,868.16 |
| Rate for Payer: Cash Price |
$1,284.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,274.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,147.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,147.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,211.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,274.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,211.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,274.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,274.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$956.05
|
| Rate for Payer: Healthfirst Commercial |
$1,274.74
|
| Rate for Payer: Healthfirst Essential Plan |
$2,868.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,211.00
|
| Rate for Payer: Healthfirst QHP |
$1,274.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$892.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,274.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,083.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$892.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,274.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$956.05
|
| Rate for Payer: SOMOS Essential |
$956.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,274.74
|
|
|
PR URETEROPLASTY PLASTIC OPERATION URETER
|
Professional
|
Both
|
$3,869.71
|
|
|
Service Code
|
HCPCS 50700
|
| Min. Negotiated Rate |
$736.59 |
| Max. Negotiated Rate |
$2,367.61 |
| Rate for Payer: Cash Price |
$1,058.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,052.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$947.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$947.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$999.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,052.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$999.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,052.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,052.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$789.20
|
| Rate for Payer: Healthfirst Commercial |
$1,052.27
|
| Rate for Payer: Healthfirst Essential Plan |
$2,367.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$999.66
|
| Rate for Payer: Healthfirst QHP |
$1,052.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$736.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,052.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$894.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$736.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,052.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$789.20
|
| Rate for Payer: SOMOS Essential |
$789.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,052.27
|
|
|
PR URETEROPYELOSTOMY ANAST URETER RENAL PELVIS
|
Professional
|
Both
|
$5,539.10
|
|
|
Service Code
|
HCPCS 50740
|
| Min. Negotiated Rate |
$1,027.06 |
| Max. Negotiated Rate |
$3,301.27 |
| Rate for Payer: Cash Price |
$1,479.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,467.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,320.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,320.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,393.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,467.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,393.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,467.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,467.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,100.42
|
| Rate for Payer: Healthfirst Commercial |
$1,467.23
|
| Rate for Payer: Healthfirst Essential Plan |
$3,301.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,393.87
|
| Rate for Payer: Healthfirst QHP |
$1,467.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,027.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,467.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,247.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,027.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,467.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,100.42
|
| Rate for Payer: SOMOS Essential |
$1,100.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,467.23
|
|
|
PR URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,525.06
|
|
|
Service Code
|
HCPCS 50900
|
| Min. Negotiated Rate |
$670.98 |
| Max. Negotiated Rate |
$2,156.72 |
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$958.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$862.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$862.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$910.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$958.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$910.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$958.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$958.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$718.90
|
| Rate for Payer: Healthfirst Commercial |
$958.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,156.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$910.61
|
| Rate for Payer: Healthfirst QHP |
$958.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$670.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$958.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$814.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$670.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$958.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$718.90
|
| Rate for Payer: SOMOS Essential |
$718.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$958.54
|
|
|
PR URETEROSIGMOIDOSTOMY W/SIGMOID BLADDER & COLOSTO
|
Professional
|
Both
|
$6,362.58
|
|
|
Service Code
|
HCPCS 50810
|
| Min. Negotiated Rate |
$1,178.77 |
| Max. Negotiated Rate |
$3,788.91 |
| Rate for Payer: Cash Price |
$1,696.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,683.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,515.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,515.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,599.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,683.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,599.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,683.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,683.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,262.97
|
| Rate for Payer: Healthfirst Commercial |
$1,683.96
|
| Rate for Payer: Healthfirst Essential Plan |
$3,788.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,599.76
|
| Rate for Payer: Healthfirst QHP |
$1,683.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,178.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,683.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,431.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,178.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,683.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,262.97
|
| Rate for Payer: SOMOS Essential |
$1,262.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,683.96
|
|
|
PR URETEROSTOMY TRANSPLANTATION URETER SKIN
|
Professional
|
Both
|
$3,948.18
|
|
|
Service Code
|
HCPCS 50860
|
| Min. Negotiated Rate |
$751.96 |
| Max. Negotiated Rate |
$2,417.02 |
| Rate for Payer: Cash Price |
$1,080.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,074.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$966.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$966.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,020.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,074.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,020.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,074.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,074.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$805.67
|
| Rate for Payer: Healthfirst Commercial |
$1,074.23
|
| Rate for Payer: Healthfirst Essential Plan |
$2,417.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,020.52
|
| Rate for Payer: Healthfirst QHP |
$1,074.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$751.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,074.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$913.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$751.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,074.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$805.67
|
| Rate for Payer: SOMOS Essential |
$805.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,074.23
|
|
|
PR URETEROTOMY INSERTION INDWELLING STENT ALL TYPES
|
Professional
|
Both
|
$4,484.55
|
|
|
Service Code
|
HCPCS 50605
|
| Min. Negotiated Rate |
$833.63 |
| Max. Negotiated Rate |
$2,679.53 |
| Rate for Payer: Cash Price |
$1,203.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,190.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,071.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,071.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,131.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,190.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,131.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,190.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$893.17
|
| Rate for Payer: Healthfirst Commercial |
$1,190.90
|
| Rate for Payer: Healthfirst Essential Plan |
$2,679.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,131.36
|
| Rate for Payer: Healthfirst QHP |
$1,190.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$833.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,190.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,012.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$833.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,190.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$893.17
|
| Rate for Payer: SOMOS Essential |
$893.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,190.90
|
|
|
PR URETEROURETEROSTOMY
|
Professional
|
Both
|
$4,865.18
|
|
|
Service Code
|
HCPCS 50760
|
| Min. Negotiated Rate |
$908.03 |
| Max. Negotiated Rate |
$2,918.66 |
| Rate for Payer: Cash Price |
$1,310.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,297.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,167.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,167.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,232.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,297.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,232.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,297.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,297.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$972.88
|
| Rate for Payer: Healthfirst Commercial |
$1,297.18
|
| Rate for Payer: Healthfirst Essential Plan |
$2,918.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,232.32
|
| Rate for Payer: Healthfirst QHP |
$1,297.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$908.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,297.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,102.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$908.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,297.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$972.88
|
| Rate for Payer: SOMOS Essential |
$972.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,297.18
|
|
|
PR URETHRECTOMY TOT W/CYSTOST FEMALE
|
Professional
|
Both
|
$3,260.36
|
|
|
Service Code
|
HCPCS 53210
|
| Min. Negotiated Rate |
$626.37 |
| Max. Negotiated Rate |
$2,013.35 |
| Rate for Payer: Cash Price |
$891.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$894.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$805.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$805.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$850.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$894.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$850.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$894.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$894.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$671.12
|
| Rate for Payer: Healthfirst Commercial |
$894.82
|
| Rate for Payer: Healthfirst Essential Plan |
$2,013.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$850.08
|
| Rate for Payer: Healthfirst QHP |
$894.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$626.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$894.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$760.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$626.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$894.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$671.12
|
| Rate for Payer: SOMOS Essential |
$671.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$894.82
|
|
|
PR URETHRECTOMY TOT W/CYSTOST MALE
|
Professional
|
Both
|
$3,879.26
|
|
|
Service Code
|
HCPCS 53215
|
| Min. Negotiated Rate |
$737.55 |
| Max. Negotiated Rate |
$2,370.71 |
| Rate for Payer: Cash Price |
$1,057.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,053.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$948.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$948.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,000.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,053.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,000.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,053.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,053.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$790.24
|
| Rate for Payer: Healthfirst Commercial |
$1,053.65
|
| Rate for Payer: Healthfirst Essential Plan |
$2,370.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,000.97
|
| Rate for Payer: Healthfirst QHP |
$1,053.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$737.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,053.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$895.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$737.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,053.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$790.24
|
| Rate for Payer: SOMOS Essential |
$790.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,053.65
|
|
|
PR URETHROLSS TRVG SEC OPN W/CSTO
|
Professional
|
Both
|
$3,195.29
|
|
|
Service Code
|
HCPCS 53500
|
| Min. Negotiated Rate |
$602.03 |
| Max. Negotiated Rate |
$1,935.11 |
| Rate for Payer: Cash Price |
$867.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$860.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$774.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$774.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$817.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$860.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$817.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$860.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$860.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$645.04
|
| Rate for Payer: Healthfirst Commercial |
$860.05
|
| Rate for Payer: Healthfirst Essential Plan |
$1,935.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$817.05
|
| Rate for Payer: Healthfirst QHP |
$860.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$602.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$860.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$731.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$602.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$860.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$645.04
|
| Rate for Payer: SOMOS Essential |
$645.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$860.05
|
|
|
PR URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT
|
Professional
|
Both
|
$1,720.88
|
|
|
Service Code
|
HCPCS 53450
|
| Min. Negotiated Rate |
$329.70 |
| Max. Negotiated Rate |
$1,059.75 |
| Rate for Payer: Cash Price |
$472.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$471.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$423.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$423.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$447.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$471.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$447.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$471.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$471.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$353.25
|
| Rate for Payer: Healthfirst Commercial |
$471.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,059.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$447.45
|
| Rate for Payer: Healthfirst QHP |
$471.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$329.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$471.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$400.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$329.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$471.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$353.25
|
| Rate for Payer: SOMOS Essential |
$353.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$471.00
|
|
|
PR URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM
|
Professional
|
Both
|
$1,921.15
|
|
|
Service Code
|
HCPCS 53460
|
| Min. Negotiated Rate |
$366.90 |
| Max. Negotiated Rate |
$1,179.32 |
| Rate for Payer: Cash Price |
$528.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$524.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$471.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$471.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$497.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$524.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$497.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$524.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$524.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$393.11
|
| Rate for Payer: Healthfirst Commercial |
$524.14
|
| Rate for Payer: Healthfirst Essential Plan |
$1,179.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$497.93
|
| Rate for Payer: Healthfirst QHP |
$524.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$366.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$524.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$445.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$366.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$524.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$393.11
|
| Rate for Payer: SOMOS Essential |
$393.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$524.14
|
|
|
PR URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA
|
Professional
|
Both
|
$4,091.36
|
|
|
Service Code
|
HCPCS 53410
|
| Min. Negotiated Rate |
$777.88 |
| Max. Negotiated Rate |
$2,500.34 |
| Rate for Payer: Cash Price |
$1,119.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,111.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,000.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,000.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,055.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,111.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,055.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,111.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,111.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$833.45
|
| Rate for Payer: Healthfirst Commercial |
$1,111.26
|
| Rate for Payer: Healthfirst Essential Plan |
$2,500.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,055.70
|
| Rate for Payer: Healthfirst QHP |
$1,111.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$777.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,111.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$944.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$777.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,111.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$833.45
|
| Rate for Payer: SOMOS Essential |
$833.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,111.26
|
|
|
PR URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX
|
Professional
|
Both
|
$3,356.01
|
|
|
Service Code
|
HCPCS 53400
|
| Min. Negotiated Rate |
$640.07 |
| Max. Negotiated Rate |
$2,057.38 |
| Rate for Payer: Cash Price |
$917.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$914.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$822.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$822.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$868.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$914.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$868.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$914.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$914.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$685.79
|
| Rate for Payer: Healthfirst Commercial |
$914.39
|
| Rate for Payer: Healthfirst Essential Plan |
$2,057.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$868.67
|
| Rate for Payer: Healthfirst QHP |
$914.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$640.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$914.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$777.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$640.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$914.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$685.79
|
| Rate for Payer: SOMOS Essential |
$685.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$914.39
|
|
|
PR URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR <3 CM
|
Professional
|
Both
|
$3,004.33
|
|
|
Service Code
|
HCPCS 54308
|
| Min. Negotiated Rate |
$571.87 |
| Max. Negotiated Rate |
$1,838.14 |
| Rate for Payer: Cash Price |
$821.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$816.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$735.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$735.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$776.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$816.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$776.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$816.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$816.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$612.71
|
| Rate for Payer: Healthfirst Commercial |
$816.95
|
| Rate for Payer: Healthfirst Essential Plan |
$1,838.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$776.10
|
| Rate for Payer: Healthfirst QHP |
$816.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$571.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$816.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$694.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$571.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$816.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$612.71
|
| Rate for Payer: SOMOS Essential |
$612.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$816.95
|
|
|
PR URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR > 3 CM
|
Professional
|
Both
|
$3,426.47
|
|
|
Service Code
|
HCPCS 54312
|
| Min. Negotiated Rate |
$652.50 |
| Max. Negotiated Rate |
$2,097.32 |
| Rate for Payer: Cash Price |
$937.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$932.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$838.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$838.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$885.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$932.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$885.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$932.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$932.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$699.11
|
| Rate for Payer: Healthfirst Commercial |
$932.14
|
| Rate for Payer: Healthfirst Essential Plan |
$2,097.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$885.53
|
| Rate for Payer: Healthfirst QHP |
$932.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$652.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$932.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$792.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$652.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$932.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$699.11
|
| Rate for Payer: SOMOS Essential |
$699.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$932.14
|
|
|
PR URETHROPLASTY 2ND STAGE HYPOSPADIAS RPR SKIN GRF
|
Professional
|
Both
|
$4,154.26
|
|
|
Service Code
|
HCPCS 54316
|
| Min. Negotiated Rate |
$789.46 |
| Max. Negotiated Rate |
$2,537.55 |
| Rate for Payer: Cash Price |
$1,135.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,127.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,015.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,015.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,071.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,127.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,071.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,127.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,127.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$845.85
|
| Rate for Payer: Healthfirst Commercial |
$1,127.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,537.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,071.41
|
| Rate for Payer: Healthfirst QHP |
$1,127.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$789.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,127.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$958.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$789.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,127.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$845.85
|
| Rate for Payer: SOMOS Essential |
$845.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,127.80
|
|
|
PR URETHROPLASTY 2ND STAGE W/URINARY DIVERSION
|
Professional
|
Both
|
$3,654.67
|
|
|
Service Code
|
HCPCS 53405
|
| Min. Negotiated Rate |
$695.41 |
| Max. Negotiated Rate |
$2,235.26 |
| Rate for Payer: Cash Price |
$998.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$993.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$894.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$894.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$943.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$993.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$943.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$993.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$993.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$745.09
|
| Rate for Payer: Healthfirst Commercial |
$993.45
|
| Rate for Payer: Healthfirst Essential Plan |
$2,235.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$943.78
|
| Rate for Payer: Healthfirst QHP |
$993.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$695.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$993.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$844.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$695.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$993.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$745.09
|
| Rate for Payer: SOMOS Essential |
$745.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$993.45
|
|
|
PR URETHROPLASTY 3RD STG HYPOSPADIAS RPR RLS PENIS
|
Professional
|
Both
|
$2,988.02
|
|
|
Service Code
|
HCPCS 54318
|
| Min. Negotiated Rate |
$569.41 |
| Max. Negotiated Rate |
$1,830.24 |
| Rate for Payer: Cash Price |
$817.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$732.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$732.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$772.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$772.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$813.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$610.08
|
| Rate for Payer: Healthfirst Commercial |
$813.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,830.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$772.77
|
| Rate for Payer: Healthfirst QHP |
$813.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$569.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$813.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$691.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$569.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$610.08
|
| Rate for Payer: SOMOS Essential |
$610.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.44
|
|
|
PR URETHROPLASTY RCNSTJ FEMALE URETHRA
|
Professional
|
Both
|
$4,123.70
|
|
|
Service Code
|
HCPCS 53430
|
| Min. Negotiated Rate |
$778.54 |
| Max. Negotiated Rate |
$2,502.45 |
| Rate for Payer: Cash Price |
$1,121.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,112.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,000.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,000.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,056.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,112.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,056.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,112.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,112.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$834.15
|
| Rate for Payer: Healthfirst Commercial |
$1,112.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,502.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,056.59
|
| Rate for Payer: Healthfirst QHP |
$1,112.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$778.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,112.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$945.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$778.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,112.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$834.15
|
| Rate for Payer: SOMOS Essential |
$834.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,112.20
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE
|
Professional
|
Both
|
$2,041.55
|
|
|
Service Code
|
HCPCS 53502
|
| Min. Negotiated Rate |
$390.70 |
| Max. Negotiated Rate |
$1,255.82 |
| Rate for Payer: Cash Price |
$561.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$558.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$502.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$502.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$530.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$558.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$530.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$558.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$558.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$418.61
|
| Rate for Payer: Healthfirst Commercial |
$558.14
|
| Rate for Payer: Healthfirst Essential Plan |
$1,255.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$530.23
|
| Rate for Payer: Healthfirst QHP |
$558.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$390.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$558.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$474.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$390.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$558.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$418.61
|
| Rate for Payer: SOMOS Essential |
$418.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$558.14
|
|
