|
PR CYSTO FRAGMENTATION URETERAL STONE
|
Professional
|
Both
|
$1,323.63
|
|
|
Service Code
|
HCPCS 52325
|
| Min. Negotiated Rate |
$250.70 |
| Max. Negotiated Rate |
$805.82 |
| Rate for Payer: Cash Price |
$360.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$358.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$322.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$322.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$340.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$358.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$340.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$358.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$358.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$268.61
|
| Rate for Payer: Healthfirst Commercial |
$358.14
|
| Rate for Payer: Healthfirst Essential Plan |
$805.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$340.23
|
| Rate for Payer: Healthfirst QHP |
$358.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$250.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$358.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$304.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$250.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$358.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$268.61
|
| Rate for Payer: SOMOS Essential |
$268.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$358.14
|
|
|
PR CYSTO INC FULG/RESCJ URTL VALVES/FOLDS
|
Professional
|
Both
|
$1,991.22
|
|
|
Service Code
|
HCPCS 52400
|
| Min. Negotiated Rate |
$378.73 |
| Max. Negotiated Rate |
$1,217.34 |
| Rate for Payer: Cash Price |
$545.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$541.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$486.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$486.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$513.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$541.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$513.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$541.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$541.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$405.78
|
| Rate for Payer: Healthfirst Commercial |
$541.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,217.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$513.99
|
| Rate for Payer: Healthfirst QHP |
$541.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$378.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$541.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$459.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$378.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$541.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$405.78
|
| Rate for Payer: SOMOS Essential |
$405.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$541.04
|
|
|
PR CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT
|
Professional
|
Both
|
$1,156.47
|
|
|
Service Code
|
HCPCS 52305
|
| Min. Negotiated Rate |
$217.83 |
| Max. Negotiated Rate |
$700.18 |
| Rate for Payer: Cash Price |
$313.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$311.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$280.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$280.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$295.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$311.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$295.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$311.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$233.39
|
| Rate for Payer: Healthfirst Commercial |
$311.19
|
| Rate for Payer: Healthfirst Essential Plan |
$700.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$295.63
|
| Rate for Payer: Healthfirst QHP |
$311.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$311.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$264.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$311.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$233.39
|
| Rate for Payer: SOMOS Essential |
$233.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$311.19
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL
|
Professional
|
Both
|
$209.65
|
|
|
Service Code
|
HCPCS 52442
|
| Min. Negotiated Rate |
$40.03 |
| Max. Negotiated Rate |
$128.68 |
| Rate for Payer: Cash Price |
$56.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.89
|
| Rate for Payer: Healthfirst Commercial |
$57.19
|
| Rate for Payer: Healthfirst Essential Plan |
$128.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.33
|
| Rate for Payer: Healthfirst QHP |
$57.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.89
|
| Rate for Payer: SOMOS Essential |
$42.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.19
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE
|
Professional
|
Both
|
$866.78
|
|
|
Service Code
|
HCPCS 52441
|
| Min. Negotiated Rate |
$165.37 |
| Max. Negotiated Rate |
$531.54 |
| Rate for Payer: Cash Price |
$236.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$236.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$212.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$212.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$224.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$236.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$224.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$236.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$177.18
|
| Rate for Payer: Healthfirst Commercial |
$236.24
|
| Rate for Payer: Healthfirst Essential Plan |
$531.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$224.43
|
| Rate for Payer: Healthfirst QHP |
$236.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$165.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$236.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$200.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$165.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$236.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$177.18
|
| Rate for Payer: SOMOS Essential |
$177.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$236.24
|
|
|
PR CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR
|
Professional
|
Both
|
$759.96
|
|
|
Service Code
|
HCPCS 52334
|
| Min. Negotiated Rate |
$144.82 |
| Max. Negotiated Rate |
$465.48 |
| Rate for Payer: Cash Price |
$206.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$206.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$186.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$186.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$196.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$206.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$196.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$206.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$206.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.16
|
| Rate for Payer: Healthfirst Commercial |
$206.88
|
| Rate for Payer: Healthfirst Essential Plan |
$465.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.54
|
| Rate for Payer: Healthfirst QHP |
$206.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$144.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$206.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$175.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$144.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$206.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.16
|
| Rate for Payer: SOMOS Essential |
$155.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$206.88
|
|
|
PR CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS
|
Professional
|
Both
|
$1,982.65
|
|
|
Service Code
|
HCPCS 51050
|
| Min. Negotiated Rate |
$379.96 |
| Max. Negotiated Rate |
$1,221.30 |
| Rate for Payer: Cash Price |
$544.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$542.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$488.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$488.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$515.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$542.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$515.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$542.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$542.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$407.10
|
| Rate for Payer: Healthfirst Commercial |
$542.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,221.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$515.66
|
| Rate for Payer: Healthfirst QHP |
$542.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$379.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$542.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$461.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$379.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$542.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$407.10
|
| Rate for Payer: SOMOS Essential |
$407.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$542.80
|
|
|
PR CYSTO MANJ W/O RMVL URETERAL STONE
|
Professional
|
Both
|
$1,087.56
|
|
|
Service Code
|
HCPCS 52330
|
| Min. Negotiated Rate |
$206.65 |
| Max. Negotiated Rate |
$664.25 |
| Rate for Payer: Cash Price |
$296.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$295.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$265.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$265.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$280.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$280.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$221.41
|
| Rate for Payer: Healthfirst Commercial |
$295.22
|
| Rate for Payer: Healthfirst Essential Plan |
$664.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$280.46
|
| Rate for Payer: Healthfirst QHP |
$295.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$206.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$295.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$250.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$206.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$295.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$221.41
|
| Rate for Payer: SOMOS Essential |
$221.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.22
|
|
|
PR CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION
|
Professional
|
Both
|
$1,721.93
|
|
|
Service Code
|
HCPCS 52354
|
| Min. Negotiated Rate |
$327.43 |
| Max. Negotiated Rate |
$1,052.46 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$467.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$420.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$420.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$444.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$467.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$444.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$467.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$467.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$350.82
|
| Rate for Payer: Healthfirst Commercial |
$467.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,052.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$444.37
|
| Rate for Payer: Healthfirst QHP |
$467.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$327.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$467.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$397.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$327.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$467.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$350.82
|
| Rate for Payer: SOMOS Essential |
$350.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$467.76
|
|
|
PR CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR
|
Professional
|
Both
|
$1,927.59
|
|
|
Service Code
|
HCPCS 52355
|
| Min. Negotiated Rate |
$366.79 |
| Max. Negotiated Rate |
$1,178.95 |
| Rate for Payer: Cash Price |
$526.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$523.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$471.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$471.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$497.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$523.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$497.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$523.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$523.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$392.99
|
| Rate for Payer: Healthfirst Commercial |
$523.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,178.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$497.78
|
| Rate for Payer: Healthfirst QHP |
$523.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$366.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$523.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$445.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$366.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$523.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$392.99
|
| Rate for Payer: SOMOS Essential |
$392.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$523.98
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED
|
Professional
|
Both
|
$3,793.51
|
|
|
Service Code
|
HCPCS 51865
|
| Min. Negotiated Rate |
$715.54 |
| Max. Negotiated Rate |
$2,299.95 |
| Rate for Payer: Cash Price |
$1,031.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,022.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$919.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$919.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$971.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,022.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$971.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,022.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,022.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$766.65
|
| Rate for Payer: Healthfirst Commercial |
$1,022.20
|
| Rate for Payer: Healthfirst Essential Plan |
$2,299.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$971.09
|
| Rate for Payer: Healthfirst QHP |
$1,022.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$715.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,022.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$868.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$715.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,022.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$766.65
|
| Rate for Payer: SOMOS Essential |
$766.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,022.20
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE
|
Professional
|
Both
|
$3,194.66
|
|
|
Service Code
|
HCPCS 51860
|
| Min. Negotiated Rate |
$600.59 |
| Max. Negotiated Rate |
$1,930.48 |
| Rate for Payer: Cash Price |
$866.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$857.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$772.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$772.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$815.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$857.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$815.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$857.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$857.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$643.49
|
| Rate for Payer: Healthfirst Commercial |
$857.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,930.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$815.09
|
| Rate for Payer: Healthfirst QHP |
$857.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$600.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$857.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$729.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$600.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$857.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$643.49
|
| Rate for Payer: SOMOS Essential |
$643.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$857.99
|
|
|
PR CYSTOSTOMY CYSTOTOMY W/DRAINAGE
|
Professional
|
Both
|
$1,229.06
|
|
|
Service Code
|
HCPCS 51040
|
| Min. Negotiated Rate |
$235.87 |
| Max. Negotiated Rate |
$758.14 |
| Rate for Payer: Cash Price |
$338.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$303.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$303.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$320.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$320.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$336.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.71
|
| Rate for Payer: Healthfirst Commercial |
$336.95
|
| Rate for Payer: Healthfirst Essential Plan |
$758.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$320.10
|
| Rate for Payer: Healthfirst QHP |
$336.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$235.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$286.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$235.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.71
|
| Rate for Payer: SOMOS Essential |
$252.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.95
|
|
|
PR CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL
|
Professional
|
Both
|
$1,978.34
|
|
|
Service Code
|
HCPCS 51020
|
| Min. Negotiated Rate |
$377.79 |
| Max. Negotiated Rate |
$1,214.33 |
| Rate for Payer: Cash Price |
$544.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$539.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$485.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$485.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$512.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$539.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$512.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$539.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$404.77
|
| Rate for Payer: Healthfirst Commercial |
$539.70
|
| Rate for Payer: Healthfirst Essential Plan |
$1,214.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$512.72
|
| Rate for Payer: Healthfirst QHP |
$539.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$377.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$539.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$458.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$377.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$539.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$404.77
|
| Rate for Payer: SOMOS Essential |
$404.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$539.70
|
|
|
PR CYSTOTOMY EXCISE BLADDER DIVERTICULUM 1/MULTIPLE
|
Professional
|
Both
|
$3,609.55
|
|
|
Service Code
|
HCPCS 51525
|
| Min. Negotiated Rate |
$683.11 |
| Max. Negotiated Rate |
$2,195.71 |
| Rate for Payer: Cash Price |
$981.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$975.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$878.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$878.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$927.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$975.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$927.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$975.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$975.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$731.90
|
| Rate for Payer: Healthfirst Commercial |
$975.87
|
| Rate for Payer: Healthfirst Essential Plan |
$2,195.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$927.08
|
| Rate for Payer: Healthfirst QHP |
$975.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$683.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$975.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$829.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$683.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$975.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$731.90
|
| Rate for Payer: SOMOS Essential |
$731.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$975.87
|
|
|
PR CYSTOTOMY EXCISE/INCISE/REPAIR URETEROCELE
|
Professional
|
Both
|
$3,266.10
|
|
|
Service Code
|
HCPCS 51535
|
| Min. Negotiated Rate |
$621.88 |
| Max. Negotiated Rate |
$1,998.90 |
| Rate for Payer: Cash Price |
$892.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$888.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$799.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$799.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$843.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$888.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$843.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$888.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$888.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$666.30
|
| Rate for Payer: Healthfirst Commercial |
$888.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,998.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$843.98
|
| Rate for Payer: Healthfirst QHP |
$888.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$621.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$888.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$755.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$621.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$888.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$666.30
|
| Rate for Payer: SOMOS Essential |
$666.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$888.40
|
|
|
PR CYSTOTOMY EXCISION BLADDER TUMOR
|
Professional
|
Both
|
$3,224.03
|
|
|
Service Code
|
HCPCS 51530
|
| Min. Negotiated Rate |
$613.66 |
| Max. Negotiated Rate |
$1,972.48 |
| Rate for Payer: Cash Price |
$882.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$876.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$788.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$788.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$832.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$876.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$832.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$876.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$876.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$657.50
|
| Rate for Payer: Healthfirst Commercial |
$876.66
|
| Rate for Payer: Healthfirst Essential Plan |
$1,972.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$832.83
|
| Rate for Payer: Healthfirst QHP |
$876.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$613.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$876.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$745.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$613.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$876.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$657.50
|
| Rate for Payer: SOMOS Essential |
$657.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$876.66
|
|
|
PR CYSTOTOMY SIMPLE EXCISION VESICAL NECK
|
Professional
|
Both
|
$2,501.10
|
|
|
Service Code
|
HCPCS 51520
|
| Min. Negotiated Rate |
$477.56 |
| Max. Negotiated Rate |
$1,535.02 |
| Rate for Payer: Cash Price |
$685.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$682.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$614.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$614.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$648.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$682.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$648.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$682.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$682.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$511.67
|
| Rate for Payer: Healthfirst Commercial |
$682.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,535.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$648.12
|
| Rate for Payer: Healthfirst QHP |
$682.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$477.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$682.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$579.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$477.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$682.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$511.67
|
| Rate for Payer: SOMOS Essential |
$511.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$682.23
|
|
|
PR CYSTOTOMY W/CALCULUS BASKET XTRJ&/FRAGMENTATIO
|
Professional
|
Both
|
$2,438.63
|
|
|
Service Code
|
HCPCS 51065
|
| Min. Negotiated Rate |
$465.37 |
| Max. Negotiated Rate |
$1,495.85 |
| Rate for Payer: Cash Price |
$668.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$664.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$598.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$598.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$631.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$664.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$631.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$664.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$664.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$498.62
|
| Rate for Payer: Healthfirst Commercial |
$664.82
|
| Rate for Payer: Healthfirst Essential Plan |
$1,495.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$631.58
|
| Rate for Payer: Healthfirst QHP |
$664.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$465.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$664.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$565.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$465.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$664.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$498.62
|
| Rate for Payer: SOMOS Essential |
$498.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$664.82
|
|
|
PR CYSTOTOMY W/INSJ URETERAL CATH/STENT SPX
|
Professional
|
Both
|
$2,168.81
|
|
|
Service Code
|
HCPCS 51045
|
| Min. Negotiated Rate |
$398.89 |
| Max. Negotiated Rate |
$1,282.14 |
| Rate for Payer: Cash Price |
$584.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$569.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$512.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$512.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$541.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$569.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$541.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$569.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$569.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$427.38
|
| Rate for Payer: Healthfirst Commercial |
$569.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,282.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$541.35
|
| Rate for Payer: Healthfirst QHP |
$569.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$398.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$569.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$484.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$398.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$569.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$427.38
|
| Rate for Payer: SOMOS Essential |
$427.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$569.84
|
|
|
PR CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT
|
Professional
|
Both
|
$1,716.16
|
|
|
Service Code
|
HCPCS 52356
|
| Min. Negotiated Rate |
$325.91 |
| Max. Negotiated Rate |
$1,047.56 |
| Rate for Payer: Cash Price |
$468.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$465.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$419.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$419.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$442.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$465.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$442.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$465.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$465.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$349.19
|
| Rate for Payer: Healthfirst Commercial |
$465.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,047.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$442.30
|
| Rate for Payer: Healthfirst QHP |
$465.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$325.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$465.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$395.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$325.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$465.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$349.19
|
| Rate for Payer: SOMOS Essential |
$349.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$465.58
|
|
|
PR CYSTOURETHROSCOPY
|
Professional
|
Both
|
$335.62
|
|
|
Service Code
|
HCPCS 52000
|
| Min. Negotiated Rate |
$63.16 |
| Max. Negotiated Rate |
$203.02 |
| Rate for Payer: Cash Price |
$91.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.67
|
| Rate for Payer: Healthfirst Commercial |
$90.23
|
| Rate for Payer: Healthfirst Essential Plan |
$203.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.72
|
| Rate for Payer: Healthfirst QHP |
$90.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.67
|
| Rate for Payer: SOMOS Essential |
$67.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.23
|
|
|
PR CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER
|
Professional
|
Both
|
$707.04
|
|
|
Service Code
|
HCPCS 52287
|
| Min. Negotiated Rate |
$133.92 |
| Max. Negotiated Rate |
$430.47 |
| Rate for Payer: Cash Price |
$191.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$181.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$181.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.49
|
| Rate for Payer: Healthfirst Commercial |
$191.32
|
| Rate for Payer: Healthfirst Essential Plan |
$430.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$181.75
|
| Rate for Payer: Healthfirst QHP |
$191.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$162.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.49
|
| Rate for Payer: SOMOS Essential |
$143.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.32
|
|
|
PR CYSTOURETHROSCOPY INSERTION PERM URETHRAL STENT
|
Professional
|
Both
|
$1,394.68
|
|
|
Service Code
|
HCPCS 52282
|
| Min. Negotiated Rate |
$265.22 |
| Max. Negotiated Rate |
$852.48 |
| Rate for Payer: Cash Price |
$381.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$378.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$340.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$340.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$359.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$378.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$359.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$378.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$378.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$284.16
|
| Rate for Payer: Healthfirst Commercial |
$378.88
|
| Rate for Payer: Healthfirst Essential Plan |
$852.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$359.94
|
| Rate for Payer: Healthfirst QHP |
$378.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$265.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$378.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$322.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$265.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$378.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$284.16
|
| Rate for Payer: SOMOS Essential |
$284.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$378.88
|
|
|
PR CYSTOURETHROSCOPY INSJ RADIOACT SBST W/WOBX/FULG
|
Professional
|
Both
|
$991.87
|
|
|
Service Code
|
HCPCS 52250
|
| Min. Negotiated Rate |
$188.15 |
| Max. Negotiated Rate |
$604.78 |
| Rate for Payer: Cash Price |
$269.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$268.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$241.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$255.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$268.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$255.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$268.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$201.59
|
| Rate for Payer: Healthfirst Commercial |
$268.79
|
| Rate for Payer: Healthfirst Essential Plan |
$604.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$255.35
|
| Rate for Payer: Healthfirst QHP |
$268.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$188.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$268.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$228.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$188.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$268.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$201.59
|
| Rate for Payer: SOMOS Essential |
$201.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.79
|
|
