|
PR CYSTOURETHROSCOPY TX FEMALE URETHRAL SYNDROME
|
Professional
|
Both
|
$812.77
|
|
|
Service Code
|
HCPCS 52285
|
| Min. Negotiated Rate |
$156.54 |
| Max. Negotiated Rate |
$503.17 |
| Rate for Payer: Cash Price |
$222.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$223.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$212.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$223.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$212.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$223.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.72
|
| Rate for Payer: Healthfirst Commercial |
$223.63
|
| Rate for Payer: Healthfirst Essential Plan |
$503.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.45
|
| Rate for Payer: Healthfirst QHP |
$223.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$223.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$223.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.72
|
| Rate for Payer: SOMOS Essential |
$167.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$223.63
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL MED BLADDER TUM
|
Professional
|
Both
|
$1,194.13
|
|
|
Service Code
|
HCPCS 52235
|
| Min. Negotiated Rate |
$226.15 |
| Max. Negotiated Rate |
$726.91 |
| Rate for Payer: Cash Price |
$325.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$323.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$290.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$290.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$306.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$323.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$306.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$323.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$323.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$242.30
|
| Rate for Payer: Healthfirst Commercial |
$323.07
|
| Rate for Payer: Healthfirst Essential Plan |
$726.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.92
|
| Rate for Payer: Healthfirst QHP |
$323.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$226.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$323.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$274.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$226.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$323.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$242.30
|
| Rate for Payer: SOMOS Essential |
$242.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$323.07
|
|
|
PR CYSTOURETHROSCOPY W/DEST &/RMVL TUMOR LARGE
|
Professional
|
Both
|
$1,621.17
|
|
|
Service Code
|
HCPCS 52240
|
| Min. Negotiated Rate |
$306.59 |
| Max. Negotiated Rate |
$985.46 |
| Rate for Payer: Cash Price |
$442.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$437.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$394.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$394.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$416.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$437.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$416.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$437.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$437.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$328.49
|
| Rate for Payer: Healthfirst Commercial |
$437.98
|
| Rate for Payer: Healthfirst Essential Plan |
$985.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$416.08
|
| Rate for Payer: Healthfirst QHP |
$437.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$306.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$437.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$372.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$306.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$437.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$328.49
|
| Rate for Payer: SOMOS Essential |
$328.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$437.98
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER GENERAL ANESTH
|
Professional
|
Both
|
$879.52
|
|
|
Service Code
|
HCPCS 52260
|
| Min. Negotiated Rate |
$166.19 |
| Max. Negotiated Rate |
$534.17 |
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$237.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$213.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$225.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$237.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$225.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$237.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$178.06
|
| Rate for Payer: Healthfirst Commercial |
$237.41
|
| Rate for Payer: Healthfirst Essential Plan |
$534.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.54
|
| Rate for Payer: Healthfirst QHP |
$237.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$166.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$237.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$201.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$237.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$178.06
|
| Rate for Payer: SOMOS Essential |
$178.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$237.41
|
|
|
PR CYSTOURETHROSCOPY W/DIL BLADDER LOCAL ANESTHESIA
|
Professional
|
Both
|
$679.21
|
|
|
Service Code
|
HCPCS 52265
|
| Min. Negotiated Rate |
$128.96 |
| Max. Negotiated Rate |
$414.52 |
| Rate for Payer: Cash Price |
$185.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$165.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.17
|
| Rate for Payer: Healthfirst Commercial |
$184.23
|
| Rate for Payer: Healthfirst Essential Plan |
$414.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.02
|
| Rate for Payer: Healthfirst QHP |
$184.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.17
|
| Rate for Payer: SOMOS Essential |
$138.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.23
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY FEMALE
|
Professional
|
Both
|
$751.66
|
|
|
Service Code
|
HCPCS 52270
|
| Min. Negotiated Rate |
$143.76 |
| Max. Negotiated Rate |
$462.08 |
| Rate for Payer: Cash Price |
$205.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$205.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$184.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$184.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$195.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$205.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$195.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$205.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$205.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.03
|
| Rate for Payer: Healthfirst Commercial |
$205.37
|
| Rate for Payer: Healthfirst Essential Plan |
$462.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$195.10
|
| Rate for Payer: Healthfirst QHP |
$205.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$205.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$174.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$143.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$205.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$154.03
|
| Rate for Payer: SOMOS Essential |
$154.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$205.37
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE
|
Professional
|
Both
|
$1,092.60
|
|
|
Service Code
|
HCPCS 52276
|
| Min. Negotiated Rate |
$207.70 |
| Max. Negotiated Rate |
$667.60 |
| Rate for Payer: Cash Price |
$298.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$296.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$267.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$267.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$281.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$296.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$281.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$296.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$296.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$222.53
|
| Rate for Payer: Healthfirst Commercial |
$296.71
|
| Rate for Payer: Healthfirst Essential Plan |
$667.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$281.87
|
| Rate for Payer: Healthfirst QHP |
$296.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$207.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$296.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$252.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$207.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$296.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$222.53
|
| Rate for Payer: SOMOS Essential |
$222.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$296.71
|
|
|
PR CYSTOURETHROSCOPY W/INTERNAL URETHROTOMY MALE
|
Professional
|
Both
|
$1,025.40
|
|
|
Service Code
|
HCPCS 52275
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$629.35 |
| Rate for Payer: Cash Price |
$279.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$279.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$251.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$265.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$279.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$265.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$279.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$209.78
|
| Rate for Payer: Healthfirst Commercial |
$279.71
|
| Rate for Payer: Healthfirst Essential Plan |
$629.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$265.72
|
| Rate for Payer: Healthfirst QHP |
$279.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$195.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$279.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$237.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$195.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$279.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$209.78
|
| Rate for Payer: SOMOS Essential |
$209.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$279.71
|
|
|
PR CYSTOURETHROSCOPY WITH BIOPSY
|
Professional
|
Both
|
$583.28
|
|
|
Service Code
|
HCPCS 52204
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$357.75 |
| Rate for Payer: Cash Price |
$160.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$159.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$143.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$151.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$159.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$159.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$159.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$119.25
|
| Rate for Payer: Healthfirst Commercial |
$159.00
|
| Rate for Payer: Healthfirst Essential Plan |
$357.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$151.05
|
| Rate for Payer: Healthfirst QHP |
$159.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$111.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$159.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$135.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$111.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$159.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$119.25
|
| Rate for Payer: SOMOS Essential |
$119.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$159.00
|
|
|
PR CYSTOURETHROSCOPY W/RESECJ EXTERNAL SPHINCTER
|
Professional
|
Both
|
$1,336.41
|
|
|
Service Code
|
HCPCS 52277
|
| Min. Negotiated Rate |
$253.38 |
| Max. Negotiated Rate |
$814.43 |
| Rate for Payer: Cash Price |
$364.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$361.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$325.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$325.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$343.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$361.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$343.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$361.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$361.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$271.48
|
| Rate for Payer: Healthfirst Commercial |
$361.97
|
| Rate for Payer: Healthfirst Essential Plan |
$814.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$343.87
|
| Rate for Payer: Healthfirst QHP |
$361.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$253.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$361.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$307.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$253.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$361.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$271.48
|
| Rate for Payer: SOMOS Essential |
$271.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$361.97
|
|
|
PR CYSTOURETHROSCOPY W/RMVL URETERAL CALCULUS
|
Professional
|
Both
|
$1,016.79
|
|
|
Service Code
|
HCPCS 52320
|
| Min. Negotiated Rate |
$193.89 |
| Max. Negotiated Rate |
$623.23 |
| Rate for Payer: Cash Price |
$277.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$276.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$249.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$263.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$276.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$263.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$276.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$276.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$207.74
|
| Rate for Payer: Healthfirst Commercial |
$276.99
|
| Rate for Payer: Healthfirst Essential Plan |
$623.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$263.14
|
| Rate for Payer: Healthfirst QHP |
$276.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$193.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$276.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$235.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$193.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$276.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$207.74
|
| Rate for Payer: SOMOS Essential |
$207.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$276.99
|
|
|
PR CYSTOURETHROSCOPY W/STEROID INJECTION STRICTURE
|
Professional
|
Both
|
$833.39
|
|
|
Service Code
|
HCPCS 52283
|
| Min. Negotiated Rate |
$159.89 |
| Max. Negotiated Rate |
$513.95 |
| Rate for Payer: Cash Price |
$228.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.31
|
| Rate for Payer: Healthfirst Commercial |
$228.42
|
| Rate for Payer: Healthfirst Essential Plan |
$513.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.00
|
| Rate for Payer: Healthfirst QHP |
$228.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.31
|
| Rate for Payer: SOMOS Essential |
$171.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.42
|
|
|
PR CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI
|
Professional
|
Both
|
$1,010.17
|
|
|
Service Code
|
HCPCS 52290
|
| Min. Negotiated Rate |
$191.58 |
| Max. Negotiated Rate |
$615.78 |
| Rate for Payer: Cash Price |
$274.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$273.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$246.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$246.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.26
|
| Rate for Payer: Healthfirst Commercial |
$273.68
|
| Rate for Payer: Healthfirst Essential Plan |
$615.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$260.00
|
| Rate for Payer: Healthfirst QHP |
$273.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$273.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$232.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$273.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$205.26
|
| Rate for Payer: SOMOS Essential |
$205.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$273.68
|
|
|
PR CYSTO W/COMPLEX REMOVAL STONE & STENT
|
Professional
|
Both
|
$1,141.21
|
|
|
Service Code
|
HCPCS 52315
|
| Min. Negotiated Rate |
$215.42 |
| Max. Negotiated Rate |
$692.41 |
| Rate for Payer: Cash Price |
$309.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$307.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$276.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$276.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$292.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$307.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$292.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$307.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$230.81
|
| Rate for Payer: Healthfirst Commercial |
$307.74
|
| Rate for Payer: Healthfirst Essential Plan |
$692.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$292.35
|
| Rate for Payer: Healthfirst QHP |
$307.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$215.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$307.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$261.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$215.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$307.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$230.81
|
| Rate for Payer: SOMOS Essential |
$230.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$307.74
|
|
|
PR CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$725.80
|
|
|
Service Code
|
HCPCS 52214
|
| Min. Negotiated Rate |
$137.51 |
| Max. Negotiated Rate |
$442.01 |
| Rate for Payer: Cash Price |
$196.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$196.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$176.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$196.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.34
|
| Rate for Payer: Healthfirst Commercial |
$196.45
|
| Rate for Payer: Healthfirst Essential Plan |
$442.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$186.63
|
| Rate for Payer: Healthfirst QHP |
$196.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$137.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$196.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$137.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$196.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$147.34
|
| Rate for Payer: SOMOS Essential |
$147.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$196.45
|
|
|
PR CYSTO W/EJACULATORY DUCT CATHETERIZATION
|
Professional
|
Both
|
$685.20
|
|
|
Service Code
|
HCPCS 52010
|
| Min. Negotiated Rate |
$131.11 |
| Max. Negotiated Rate |
$421.43 |
| Rate for Payer: Cash Price |
$187.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$187.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$168.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$168.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$177.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$187.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$177.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.47
|
| Rate for Payer: Healthfirst Commercial |
$187.30
|
| Rate for Payer: Healthfirst Essential Plan |
$421.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$177.94
|
| Rate for Payer: Healthfirst QHP |
$187.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$131.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$187.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$159.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$131.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$187.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.47
|
| Rate for Payer: SOMOS Essential |
$140.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$187.30
|
|
|
PR CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$647.33
|
|
|
Service Code
|
HCPCS 52332
|
| Min. Negotiated Rate |
$123.09 |
| Max. Negotiated Rate |
$395.64 |
| Rate for Payer: Cash Price |
$176.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.88
|
| Rate for Payer: Healthfirst Commercial |
$175.84
|
| Rate for Payer: Healthfirst Essential Plan |
$395.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.05
|
| Rate for Payer: Healthfirst QHP |
$175.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.88
|
| Rate for Payer: SOMOS Essential |
$131.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.84
|
|
|
PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Professional
|
Both
|
$1,188.39
|
|
|
Service Code
|
HCPCS 52001
|
| Min. Negotiated Rate |
$225.06 |
| Max. Negotiated Rate |
$723.42 |
| Rate for Payer: Cash Price |
$324.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$321.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$305.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$321.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$305.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$241.14
|
| Rate for Payer: Healthfirst Commercial |
$321.52
|
| Rate for Payer: Healthfirst Essential Plan |
$723.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$305.44
|
| Rate for Payer: Healthfirst QHP |
$321.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$225.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$321.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$273.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$225.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$321.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$241.14
|
| Rate for Payer: SOMOS Essential |
$241.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$321.52
|
|
|
PR CYSTO W/REMOVAL OF LESIONS SMALL
|
Professional
|
Both
|
$841.12
|
|
|
Service Code
|
HCPCS 52224
|
| Min. Negotiated Rate |
$158.97 |
| Max. Negotiated Rate |
$510.98 |
| Rate for Payer: Cash Price |
$227.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$227.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$204.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$204.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.32
|
| Rate for Payer: Healthfirst Commercial |
$227.10
|
| Rate for Payer: Healthfirst Essential Plan |
$510.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.75
|
| Rate for Payer: Healthfirst QHP |
$227.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.32
|
| Rate for Payer: SOMOS Essential |
$170.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.10
|
|
|
PR CYSTO W/REMOVAL OF TUMORS SMALL
|
Professional
|
Both
|
$1,018.08
|
|
|
Service Code
|
HCPCS 52234
|
| Min. Negotiated Rate |
$193.24 |
| Max. Negotiated Rate |
$621.13 |
| Rate for Payer: Cash Price |
$277.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$276.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$248.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$248.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$262.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$276.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$262.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$276.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$276.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$207.04
|
| Rate for Payer: Healthfirst Commercial |
$276.06
|
| Rate for Payer: Healthfirst Essential Plan |
$621.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$262.26
|
| Rate for Payer: Healthfirst QHP |
$276.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$193.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$276.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$234.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$193.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$276.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$207.04
|
| Rate for Payer: SOMOS Essential |
$207.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$276.06
|
|
|
PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$1,163.68
|
|
|
Service Code
|
HCPCS 52300
|
| Min. Negotiated Rate |
$219.46 |
| Max. Negotiated Rate |
$705.42 |
| Rate for Payer: Cash Price |
$315.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$313.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$282.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$282.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$297.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$313.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$297.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$313.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$235.14
|
| Rate for Payer: Healthfirst Commercial |
$313.52
|
| Rate for Payer: Healthfirst Essential Plan |
$705.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$297.84
|
| Rate for Payer: Healthfirst QHP |
$313.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$219.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$313.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$266.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$313.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$235.14
|
| Rate for Payer: SOMOS Essential |
$235.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$313.52
|
|
|
PR CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$1,198.79
|
|
|
Service Code
|
HCPCS 52301
|
| Min. Negotiated Rate |
$227.49 |
| Max. Negotiated Rate |
$731.21 |
| Rate for Payer: Cash Price |
$327.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$292.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$292.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$308.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$308.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$324.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$324.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$243.74
|
| Rate for Payer: Healthfirst Commercial |
$324.98
|
| Rate for Payer: Healthfirst Essential Plan |
$731.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.73
|
| Rate for Payer: Healthfirst QHP |
$324.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$227.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$324.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$276.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$227.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$243.74
|
| Rate for Payer: SOMOS Essential |
$243.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.98
|
|
|
PR CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Professional
|
Both
|
$630.28
|
|
|
Service Code
|
HCPCS 52310
|
| Min. Negotiated Rate |
$119.86 |
| Max. Negotiated Rate |
$385.27 |
| Rate for Payer: Cash Price |
$171.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$171.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$154.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$171.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$171.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.42
|
| Rate for Payer: Healthfirst Commercial |
$171.23
|
| Rate for Payer: Healthfirst Essential Plan |
$385.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.67
|
| Rate for Payer: Healthfirst QHP |
$171.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$171.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$171.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$128.42
|
| Rate for Payer: SOMOS Essential |
$128.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$171.23
|
|
|
PR CYSTO W/SUBURTRIC NJX IMPLT MATRL
|
Professional
|
Both
|
$1,068.83
|
|
|
Service Code
|
HCPCS 52327
|
| Min. Negotiated Rate |
$202.71 |
| Max. Negotiated Rate |
$651.58 |
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$289.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$260.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$260.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$275.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$289.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$275.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$289.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$289.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$217.19
|
| Rate for Payer: Healthfirst Commercial |
$289.59
|
| Rate for Payer: Healthfirst Essential Plan |
$651.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.11
|
| Rate for Payer: Healthfirst QHP |
$289.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$202.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$289.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$246.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$202.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$289.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$217.19
|
| Rate for Payer: SOMOS Essential |
$217.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$289.59
|
|
|
PR CYSTO W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$1,423.35
|
|
|
Service Code
|
HCPCS 52343
|
| Min. Negotiated Rate |
$270.28 |
| Max. Negotiated Rate |
$868.75 |
| Rate for Payer: Cash Price |
$387.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$386.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$347.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$347.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$366.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$386.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$366.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$386.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$386.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.58
|
| Rate for Payer: Healthfirst Commercial |
$386.11
|
| Rate for Payer: Healthfirst Essential Plan |
$868.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$366.80
|
| Rate for Payer: Healthfirst QHP |
$386.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$386.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$328.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$386.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$289.58
|
| Rate for Payer: SOMOS Essential |
$289.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$386.11
|
|
