|
PR INSERT DRUG DEL IMPLANT, >=4
|
Professional
|
Both
|
$391.72
|
|
|
Service Code
|
HCPCS G0516
|
| Min. Negotiated Rate |
$74.62 |
| Max. Negotiated Rate |
$239.85 |
| Rate for Payer: Cash Price |
$107.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.95
|
| Rate for Payer: Healthfirst Commercial |
$106.60
|
| Rate for Payer: Healthfirst Essential Plan |
$239.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.27
|
| Rate for Payer: Healthfirst QHP |
$106.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.95
|
| Rate for Payer: SOMOS Essential |
$79.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.60
|
|
|
PR INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ
|
Professional
|
Both
|
$1,000.69
|
|
|
Service Code
|
HCPCS 49441
|
| Min. Negotiated Rate |
$191.35 |
| Max. Negotiated Rate |
$615.06 |
| Rate for Payer: Cash Price |
$272.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$273.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$246.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$246.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$259.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$259.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.02
|
| Rate for Payer: Healthfirst Commercial |
$273.36
|
| Rate for Payer: Healthfirst Essential Plan |
$615.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$259.69
|
| Rate for Payer: Healthfirst QHP |
$273.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$273.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$232.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$273.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$205.02
|
| Rate for Payer: SOMOS Essential |
$205.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$273.36
|
|
|
PR INSERT GASTROSTOMY TUBE PERCUTANEOUS
|
Professional
|
Both
|
$835.84
|
|
|
Service Code
|
HCPCS 49440
|
| Min. Negotiated Rate |
$158.05 |
| Max. Negotiated Rate |
$508.00 |
| Rate for Payer: Cash Price |
$225.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$214.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$214.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.34
|
| Rate for Payer: Healthfirst Commercial |
$225.78
|
| Rate for Payer: Healthfirst Essential Plan |
$508.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$214.49
|
| Rate for Payer: Healthfirst QHP |
$225.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$225.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.34
|
| Rate for Payer: SOMOS Essential |
$169.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.78
|
|
|
PR INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY
|
Professional
|
Both
|
$3,337.57
|
|
|
Service Code
|
HCPCS 19340
|
| Min. Negotiated Rate |
$628.35 |
| Max. Negotiated Rate |
$2,019.69 |
| Rate for Payer: Cash Price |
$900.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$897.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$807.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$807.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$852.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$897.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$852.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$897.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$897.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$673.23
|
| Rate for Payer: Healthfirst Commercial |
$897.64
|
| Rate for Payer: Healthfirst Essential Plan |
$2,019.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$852.76
|
| Rate for Payer: Healthfirst QHP |
$897.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$628.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$897.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$762.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$628.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$897.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$673.23
|
| Rate for Payer: SOMOS Essential |
$673.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$897.64
|
|
|
PR INSERTION CERVICAL DILATOR SEPARATE PROCEDURE
|
Professional
|
Both
|
$203.70
|
|
|
Service Code
|
HCPCS 59200
|
| Min. Negotiated Rate |
$56.85 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Cash Price |
$54.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.91
|
| Rate for Payer: Healthfirst Commercial |
$81.22
|
| Rate for Payer: Healthfirst Essential Plan |
$182.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.16
|
| Rate for Payer: Healthfirst QHP |
$81.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.91
|
| Rate for Payer: SOMOS Essential |
$60.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.22
|
|
|
PR INSERTION DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$272.27
|
|
|
Service Code
|
HCPCS 11981
|
| Min. Negotiated Rate |
$51.25 |
| Max. Negotiated Rate |
$164.72 |
| Rate for Payer: Cash Price |
$73.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.91
|
| Rate for Payer: Healthfirst Commercial |
$73.21
|
| Rate for Payer: Healthfirst Essential Plan |
$164.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.55
|
| Rate for Payer: Healthfirst QHP |
$73.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.91
|
| Rate for Payer: SOMOS Essential |
$54.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.21
|
|
|
PR INSERTION EPICARDIAL ELECTRODE ENDOSCOPIC
|
Professional
|
Both
|
$3,603.32
|
|
|
Service Code
|
HCPCS 33203
|
| Min. Negotiated Rate |
$666.37 |
| Max. Negotiated Rate |
$2,141.89 |
| Rate for Payer: Cash Price |
$960.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$951.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$856.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$856.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$904.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$951.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$904.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$951.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$951.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$713.96
|
| Rate for Payer: Healthfirst Commercial |
$951.95
|
| Rate for Payer: Healthfirst Essential Plan |
$2,141.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$904.35
|
| Rate for Payer: Healthfirst QHP |
$951.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$666.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$951.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$809.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$666.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$951.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$713.96
|
| Rate for Payer: SOMOS Essential |
$713.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$951.95
|
|
|
PR INSERTION EPICARDIAL ELECTRODE OPEN
|
Professional
|
Both
|
$3,423.07
|
|
|
Service Code
|
HCPCS 33202
|
| Min. Negotiated Rate |
$631.67 |
| Max. Negotiated Rate |
$2,030.36 |
| Rate for Payer: Cash Price |
$911.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$902.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$812.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$812.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$857.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$902.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$857.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$902.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$902.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$676.78
|
| Rate for Payer: Healthfirst Commercial |
$902.38
|
| Rate for Payer: Healthfirst Essential Plan |
$2,030.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$857.26
|
| Rate for Payer: Healthfirst QHP |
$902.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$631.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$902.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$767.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$631.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$902.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$676.78
|
| Rate for Payer: SOMOS Essential |
$676.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$902.38
|
|
|
PR INSERTION FLOW DIRECTED CATHETER FOR MONITORING
|
Professional
|
Both
|
$357.25
|
|
|
Service Code
|
HCPCS 93503
|
| Min. Negotiated Rate |
$66.72 |
| Max. Negotiated Rate |
$214.47 |
| Rate for Payer: Amida Care Medicaid |
$141.40
|
| Rate for Payer: Cash Price |
$96.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.49
|
| Rate for Payer: Healthfirst Commercial |
$95.32
|
| Rate for Payer: Healthfirst Essential Plan |
$214.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.55
|
| Rate for Payer: Healthfirst QHP |
$95.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.49
|
| Rate for Payer: SOMOS Essential |
$71.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.32
|
|
|
PR INSERTION HEYMAN CAPSULES CLINICAL BRACHYTHERAPY
|
Professional
|
Both
|
$2,068.68
|
|
|
Service Code
|
HCPCS 58346
|
| Min. Negotiated Rate |
$398.46 |
| Max. Negotiated Rate |
$1,280.77 |
| Rate for Payer: Cash Price |
$567.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$569.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$512.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$512.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$540.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$569.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$540.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$569.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$569.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$426.92
|
| Rate for Payer: Healthfirst Commercial |
$569.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,280.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$540.77
|
| Rate for Payer: Healthfirst QHP |
$569.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$398.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$569.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$483.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$398.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$569.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$426.92
|
| Rate for Payer: SOMOS Essential |
$426.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$569.23
|
|
|
PR INSERTION INDWELLING TUNNELED PLEURAL CATHETER
|
Professional
|
Both
|
$860.09
|
|
|
Service Code
|
HCPCS 32550
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$514.15 |
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.38
|
| Rate for Payer: Healthfirst Commercial |
$228.51
|
| Rate for Payer: Healthfirst Essential Plan |
$514.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.08
|
| Rate for Payer: Healthfirst QHP |
$228.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.38
|
| Rate for Payer: SOMOS Essential |
$171.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.51
|
|
|
PR INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ
|
Professional
|
Both
|
$1,130.54
|
|
|
Service Code
|
HCPCS 33967
|
| Min. Negotiated Rate |
$209.14 |
| Max. Negotiated Rate |
$672.23 |
| Rate for Payer: Cash Price |
$301.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$298.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$268.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$268.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$283.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$298.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$283.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$298.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$298.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$224.08
|
| Rate for Payer: Healthfirst Commercial |
$298.77
|
| Rate for Payer: Healthfirst Essential Plan |
$672.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$283.83
|
| Rate for Payer: Healthfirst QHP |
$298.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$209.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$298.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$253.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$209.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$298.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$224.08
|
| Rate for Payer: SOMOS Essential |
$224.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$298.77
|
|
|
PR INSERTION NASAL SEPTAL PROSTHESIS BUTTON
|
Professional
|
Both
|
$551.15
|
|
|
Service Code
|
HCPCS 30220
|
| Min. Negotiated Rate |
$104.65 |
| Max. Negotiated Rate |
$336.38 |
| Rate for Payer: Cash Price |
$151.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$149.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$149.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.12
|
| Rate for Payer: Healthfirst Commercial |
$149.50
|
| Rate for Payer: Healthfirst Essential Plan |
$336.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.03
|
| Rate for Payer: Healthfirst QHP |
$149.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$149.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.12
|
| Rate for Payer: SOMOS Essential |
$112.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.50
|
|
|
PR INSERTION PERITONEAL-VENOUS SHUNT
|
Professional
|
Both
|
$3,533.60
|
|
|
Service Code
|
HCPCS 49425
|
| Min. Negotiated Rate |
$656.12 |
| Max. Negotiated Rate |
$2,108.97 |
| Rate for Payer: Cash Price |
$944.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$937.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$843.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$843.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$890.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$937.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$890.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$937.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$937.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$702.99
|
| Rate for Payer: Healthfirst Commercial |
$937.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,108.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$890.45
|
| Rate for Payer: Healthfirst QHP |
$937.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$656.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$937.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$796.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$656.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$937.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$702.99
|
| Rate for Payer: SOMOS Essential |
$702.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$937.32
|
|
|
PR INSERTION PICC W/O IMG GDN < 5 YR
|
Professional
|
Both
|
$383.01
|
|
|
Service Code
|
HCPCS 36568
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$231.50 |
| Rate for Payer: Cash Price |
$102.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$97.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.17
|
| Rate for Payer: Healthfirst Commercial |
$102.89
|
| Rate for Payer: Healthfirst Essential Plan |
$231.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$97.75
|
| Rate for Payer: Healthfirst QHP |
$102.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.17
|
| Rate for Payer: SOMOS Essential |
$77.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.89
|
|
|
PR INSERTION PICC W/O IMG GDN 5 YR/>
|
Professional
|
Both
|
$393.93
|
|
|
Service Code
|
HCPCS 36569
|
| Min. Negotiated Rate |
$75.22 |
| Max. Negotiated Rate |
$241.76 |
| Rate for Payer: Cash Price |
$107.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.59
|
| Rate for Payer: Healthfirst Commercial |
$107.45
|
| Rate for Payer: Healthfirst Essential Plan |
$241.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.08
|
| Rate for Payer: Healthfirst QHP |
$107.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.59
|
| Rate for Payer: SOMOS Essential |
$80.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.45
|
|
|
PR INSERTION PICC W/RS&I < 5 YR
|
Professional
|
Both
|
$337.02
|
|
|
Service Code
|
HCPCS 36572
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$203.11 |
| Rate for Payer: Cash Price |
$90.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.70
|
| Rate for Payer: Healthfirst Commercial |
$90.27
|
| Rate for Payer: Healthfirst Essential Plan |
$203.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.76
|
| Rate for Payer: Healthfirst QHP |
$90.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.70
|
| Rate for Payer: SOMOS Essential |
$67.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.27
|
|
|
PR INSERTION PICC W/RS&I 5 YR/>
|
Professional
|
Both
|
$346.99
|
|
|
Service Code
|
HCPCS 36573
|
| Min. Negotiated Rate |
$64.38 |
| Max. Negotiated Rate |
$206.93 |
| Rate for Payer: Cash Price |
$92.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.98
|
| Rate for Payer: Healthfirst Commercial |
$91.97
|
| Rate for Payer: Healthfirst Essential Plan |
$206.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.37
|
| Rate for Payer: Healthfirst QHP |
$91.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.98
|
| Rate for Payer: SOMOS Essential |
$68.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.97
|
|
|
PR INSERTION SPHENOIDAL ELECTRODES EEG PHYS/QHP
|
Professional
|
Both
|
$373.42
|
|
|
Service Code
|
HCPCS 95830
|
| Min. Negotiated Rate |
$43.15 |
| Max. Negotiated Rate |
$228.62 |
| Rate for Payer: Amida Care Medicaid |
$43.15
|
| Rate for Payer: Cash Price |
$102.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$101.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.21
|
| Rate for Payer: Healthfirst Commercial |
$101.61
|
| Rate for Payer: Healthfirst Essential Plan |
$228.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.53
|
| Rate for Payer: Healthfirst QHP |
$101.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.21
|
| Rate for Payer: SOMOS Essential |
$76.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.61
|
|
|
PR INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG
|
Professional
|
Both
|
$389.45
|
|
|
Service Code
|
HCPCS 33285
|
| Min. Negotiated Rate |
$71.06 |
| Max. Negotiated Rate |
$228.40 |
| Rate for Payer: Cash Price |
$102.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$101.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.13
|
| Rate for Payer: Healthfirst Commercial |
$101.51
|
| Rate for Payer: Healthfirst Essential Plan |
$228.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.43
|
| Rate for Payer: Healthfirst QHP |
$101.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.13
|
| Rate for Payer: SOMOS Essential |
$76.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.51
|
|
|
PR INSERTION TANDEM CUFF
|
Professional
|
Both
|
$3,316.64
|
|
|
Service Code
|
HCPCS 53444
|
| Min. Negotiated Rate |
$632.62 |
| Max. Negotiated Rate |
$2,033.41 |
| Rate for Payer: Cash Price |
$908.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$903.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$813.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$813.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$858.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$903.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$858.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$903.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$903.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$677.80
|
| Rate for Payer: Healthfirst Commercial |
$903.74
|
| Rate for Payer: Healthfirst Essential Plan |
$2,033.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$858.55
|
| Rate for Payer: Healthfirst QHP |
$903.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$632.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$903.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$768.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$632.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$903.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$677.80
|
| Rate for Payer: SOMOS Essential |
$677.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$903.74
|
|
|
PR INSERTION THOMAS SHUNT SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,153.31
|
|
|
Service Code
|
HCPCS 36835
|
| Min. Negotiated Rate |
$400.11 |
| Max. Negotiated Rate |
$1,286.06 |
| Rate for Payer: Cash Price |
$575.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$571.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$514.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$514.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$543.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$571.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$543.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$571.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$571.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$428.69
|
| Rate for Payer: Healthfirst Commercial |
$571.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,286.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$543.00
|
| Rate for Payer: Healthfirst QHP |
$571.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$400.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$571.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$485.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$400.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$571.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$428.69
|
| Rate for Payer: SOMOS Essential |
$428.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$571.58
|
|
|
PR INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ
|
Professional
|
Both
|
$4,408.92
|
|
|
Service Code
|
HCPCS 11960
|
| Min. Negotiated Rate |
$837.42 |
| Max. Negotiated Rate |
$2,691.72 |
| Rate for Payer: Cash Price |
$1,198.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,196.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,076.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,076.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,136.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,196.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,196.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,196.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$897.24
|
| Rate for Payer: Healthfirst Commercial |
$1,196.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,691.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,136.50
|
| Rate for Payer: Healthfirst QHP |
$1,196.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$837.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,196.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,016.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$837.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,196.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$897.24
|
| Rate for Payer: SOMOS Essential |
$897.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,196.32
|
|
|
PR INSERTION TUNNEL INTRAPERITONEAL CATH DIAL OPEN
|
Professional
|
Both
|
$1,012.52
|
|
|
Service Code
|
HCPCS 49421
|
| Min. Negotiated Rate |
$186.91 |
| Max. Negotiated Rate |
$600.77 |
| Rate for Payer: Cash Price |
$269.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$267.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$240.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$253.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$267.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$253.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.26
|
| Rate for Payer: Healthfirst Commercial |
$267.01
|
| Rate for Payer: Healthfirst Essential Plan |
$600.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$253.66
|
| Rate for Payer: Healthfirst QHP |
$267.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$186.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$267.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$226.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$186.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$267.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.26
|
| Rate for Payer: SOMOS Essential |
$200.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$267.01
|
|
|
PR INSERTION TUNNEL INTRAPERITONEAL CATH SUBQ PORT
|
Professional
|
Both
|
$1,858.08
|
|
|
Service Code
|
HCPCS 49419
|
| Min. Negotiated Rate |
$341.70 |
| Max. Negotiated Rate |
$1,098.34 |
| Rate for Payer: Cash Price |
$494.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$439.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$463.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$463.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$488.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$488.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$366.11
|
| Rate for Payer: Healthfirst Commercial |
$488.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,098.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$463.74
|
| Rate for Payer: Healthfirst QHP |
$488.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$341.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$488.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$414.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$341.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$366.11
|
| Rate for Payer: SOMOS Essential |
$366.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.15
|
|
