|
PR INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN
|
Professional
|
Both
|
$2,051.07
|
|
|
Service Code
|
HCPCS 33225
|
| Min. Negotiated Rate |
$373.40 |
| Max. Negotiated Rate |
$1,200.22 |
| Rate for Payer: Cash Price |
$538.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$533.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$480.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$480.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$506.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$533.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$506.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$533.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$533.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$400.07
|
| Rate for Payer: Healthfirst Commercial |
$533.43
|
| Rate for Payer: Healthfirst Essential Plan |
$1,200.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$506.76
|
| Rate for Payer: Healthfirst QHP |
$533.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$373.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$533.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$453.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$373.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$533.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$400.07
|
| Rate for Payer: SOMOS Essential |
$400.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$533.43
|
|
|
PR INSJ GRAFT AORTA/GREAT VESSEL W/BYPASS
|
Professional
|
Both
|
$8,227.91
|
|
|
Service Code
|
HCPCS 33335
|
| Min. Negotiated Rate |
$1,516.77 |
| Max. Negotiated Rate |
$4,875.32 |
| Rate for Payer: Cash Price |
$2,184.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,166.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,950.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,950.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,058.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,166.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,058.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,166.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,166.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,625.11
|
| Rate for Payer: Healthfirst Commercial |
$2,166.81
|
| Rate for Payer: Healthfirst Essential Plan |
$4,875.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,058.47
|
| Rate for Payer: Healthfirst QHP |
$2,166.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,516.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,166.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,841.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,516.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,166.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,625.11
|
| Rate for Payer: SOMOS Essential |
$1,625.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,166.81
|
|
|
PR INSJ GRAFT AORTA/GREAT VESSEL W/O SHUNT/BYPASS
|
Professional
|
Both
|
$6,274.03
|
|
|
Service Code
|
HCPCS 33330
|
| Min. Negotiated Rate |
$1,159.10 |
| Max. Negotiated Rate |
$3,725.68 |
| Rate for Payer: Cash Price |
$1,669.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,655.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,490.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,490.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,573.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,655.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,573.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,655.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,241.89
|
| Rate for Payer: Healthfirst Commercial |
$1,655.86
|
| Rate for Payer: Healthfirst Essential Plan |
$3,725.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,573.07
|
| Rate for Payer: Healthfirst QHP |
$1,655.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,159.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,655.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,407.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,159.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,655.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,241.89
|
| Rate for Payer: SOMOS Essential |
$1,241.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,655.86
|
|
|
PR INSJ I-AORT BALO ASSIST DEV VIA ASCENDING AORTA
|
Professional
|
Both
|
$2,208.36
|
|
|
Service Code
|
HCPCS 33973
|
| Min. Negotiated Rate |
$404.59 |
| Max. Negotiated Rate |
$1,300.45 |
| Rate for Payer: Cash Price |
$582.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$577.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$520.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$520.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$549.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$577.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$549.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$577.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$577.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$433.49
|
| Rate for Payer: Healthfirst Commercial |
$577.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,300.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$549.08
|
| Rate for Payer: Healthfirst QHP |
$577.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$404.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$577.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$491.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$404.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$577.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$433.49
|
| Rate for Payer: SOMOS Essential |
$433.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$577.98
|
|
|
PR INSJ IMPLANTABLE INTRA-ARTERIAL INFUSION PUM
|
Professional
|
Both
|
$2,961.98
|
|
|
Service Code
|
HCPCS 36260
|
| Min. Negotiated Rate |
$550.82 |
| Max. Negotiated Rate |
$1,770.50 |
| Rate for Payer: Cash Price |
$793.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$786.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$708.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$708.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$747.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$786.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$747.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$786.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$786.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$590.17
|
| Rate for Payer: Healthfirst Commercial |
$786.89
|
| Rate for Payer: Healthfirst Essential Plan |
$1,770.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$747.55
|
| Rate for Payer: Healthfirst QHP |
$786.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$550.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$786.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$668.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$550.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$786.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$590.17
|
| Rate for Payer: SOMOS Essential |
$590.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$786.89
|
|
|
PR INSJ IMPLNTBL DEFIB PULSE GEN W/1 EXISTING LD
|
Professional
|
Both
|
$1,618.33
|
|
|
Service Code
|
HCPCS 33240
|
| Min. Negotiated Rate |
$293.49 |
| Max. Negotiated Rate |
$943.36 |
| Rate for Payer: Cash Price |
$432.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$419.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$377.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$377.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$398.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$419.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$398.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$419.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$419.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$314.45
|
| Rate for Payer: Healthfirst Commercial |
$419.27
|
| Rate for Payer: Healthfirst Essential Plan |
$943.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$398.31
|
| Rate for Payer: Healthfirst QHP |
$419.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$293.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$419.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$356.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$293.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$419.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$314.45
|
| Rate for Payer: SOMOS Essential |
$314.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$419.27
|
|
|
PR INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST DUAL LEADS
|
Professional
|
Both
|
$1,689.24
|
|
|
Service Code
|
HCPCS 33230
|
| Min. Negotiated Rate |
$304.61 |
| Max. Negotiated Rate |
$979.09 |
| Rate for Payer: Cash Price |
$439.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$435.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$391.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$413.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$435.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$413.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$435.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$435.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$326.36
|
| Rate for Payer: Healthfirst Commercial |
$435.15
|
| Rate for Payer: Healthfirst Essential Plan |
$979.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$413.39
|
| Rate for Payer: Healthfirst QHP |
$435.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$304.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$435.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$369.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$304.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$435.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$326.36
|
| Rate for Payer: SOMOS Essential |
$326.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$435.15
|
|
|
PR INSJ IMPLNTBL DEFIB PULSE GEN W/EXIST MULTILEADS
|
Professional
|
Both
|
$1,759.73
|
|
|
Service Code
|
HCPCS 33231
|
| Min. Negotiated Rate |
$325.73 |
| Max. Negotiated Rate |
$1,046.99 |
| Rate for Payer: Cash Price |
$470.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$465.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$418.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$418.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$442.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$465.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$442.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$465.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$465.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$349.00
|
| Rate for Payer: Healthfirst Commercial |
$465.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,046.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$442.06
|
| Rate for Payer: Healthfirst QHP |
$465.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$325.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$465.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$395.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$325.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$465.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$349.00
|
| Rate for Payer: SOMOS Essential |
$349.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$465.33
|
|
|
PR INSJ INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Professional
|
Both
|
$3,175.03
|
|
|
Service Code
|
HCPCS 53445
|
| Min. Negotiated Rate |
$605.31 |
| Max. Negotiated Rate |
$1,945.64 |
| Rate for Payer: Cash Price |
$869.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$864.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$778.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$778.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$821.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$864.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$821.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$864.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$864.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$648.55
|
| Rate for Payer: Healthfirst Commercial |
$864.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,945.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$821.49
|
| Rate for Payer: Healthfirst QHP |
$864.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$605.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$864.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$735.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$605.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$864.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$648.55
|
| Rate for Payer: SOMOS Essential |
$648.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$864.73
|
|
|
PR INSJ INTRA-AORT BALO ASSIST DEV VIA FEM ART OPEN
|
Professional
|
Both
|
$1,559.08
|
|
|
Service Code
|
HCPCS 33970
|
| Min. Negotiated Rate |
$285.73 |
| Max. Negotiated Rate |
$918.43 |
| Rate for Payer: Cash Price |
$411.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$408.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$367.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$367.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$387.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$408.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$387.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$408.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$408.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$306.14
|
| Rate for Payer: Healthfirst Commercial |
$408.19
|
| Rate for Payer: Healthfirst Essential Plan |
$918.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$387.78
|
| Rate for Payer: Healthfirst QHP |
$408.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$285.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$408.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$346.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$285.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$408.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$306.14
|
| Rate for Payer: SOMOS Essential |
$306.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$408.19
|
|
|
PR INSJ INTRAPERITONEAL CATHETER W/IMG GUID
|
Professional
|
Both
|
$829.26
|
|
|
Service Code
|
HCPCS 49418
|
| Min. Negotiated Rate |
$155.83 |
| Max. Negotiated Rate |
$500.89 |
| Rate for Payer: Cash Price |
$222.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$222.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$200.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$200.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$211.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$222.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$211.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$222.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$222.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.97
|
| Rate for Payer: Healthfirst Commercial |
$222.62
|
| Rate for Payer: Healthfirst Essential Plan |
$500.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$211.49
|
| Rate for Payer: Healthfirst QHP |
$222.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$155.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$222.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$189.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$155.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$222.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.97
|
| Rate for Payer: SOMOS Essential |
$166.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$222.62
|
|
|
PR INSJ IO LENS PROSTHESIS NOT W/CONCURRENT RMVL
|
Professional
|
Both
|
$3,162.92
|
|
|
Service Code
|
HCPCS 66985
|
| Min. Negotiated Rate |
$602.25 |
| Max. Negotiated Rate |
$1,935.81 |
| Rate for Payer: Cash Price |
$871.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$860.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$774.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$774.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$817.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$860.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$817.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$860.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$860.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$645.27
|
| Rate for Payer: Healthfirst Commercial |
$860.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,935.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$817.34
|
| Rate for Payer: Healthfirst QHP |
$860.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$602.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$860.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$731.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$602.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$860.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$645.27
|
| Rate for Payer: SOMOS Essential |
$645.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$860.36
|
|
|
PR INSJ MESH/PROSTH PELVIC FLOOR DEFECT EACH SITE
|
Professional
|
Both
|
$1,075.31
|
|
|
Service Code
|
HCPCS 57267
|
| Min. Negotiated Rate |
$199.96 |
| Max. Negotiated Rate |
$642.74 |
| Rate for Payer: Cash Price |
$289.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$257.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$257.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$271.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$271.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$214.25
|
| Rate for Payer: Healthfirst Commercial |
$285.66
|
| Rate for Payer: Healthfirst Essential Plan |
$642.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$271.38
|
| Rate for Payer: Healthfirst QHP |
$285.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$285.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$242.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$214.25
|
| Rate for Payer: SOMOS Essential |
$214.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.66
|
|
|
PR INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH
|
Professional
|
Both
|
$3,384.47
|
|
|
Service Code
|
HCPCS 54405
|
| Min. Negotiated Rate |
$644.37 |
| Max. Negotiated Rate |
$2,071.19 |
| Rate for Payer: Cash Price |
$924.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$920.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$828.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$874.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$920.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$874.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$920.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$690.40
|
| Rate for Payer: Healthfirst Commercial |
$920.53
|
| Rate for Payer: Healthfirst Essential Plan |
$2,071.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$874.50
|
| Rate for Payer: Healthfirst QHP |
$920.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$644.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$920.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$782.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$644.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$920.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$690.40
|
| Rate for Payer: SOMOS Essential |
$690.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$920.53
|
|
|
PR INSJ NON-NDWELLG BLADDER CATHETER
|
Professional
|
Both
|
$107.66
|
|
|
Service Code
|
HCPCS 51701
|
| Min. Negotiated Rate |
$19.82 |
| Max. Negotiated Rate |
$63.70 |
| Rate for Payer: Cash Price |
$29.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.23
|
| Rate for Payer: Healthfirst Commercial |
$28.31
|
| Rate for Payer: Healthfirst Essential Plan |
$63.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.89
|
| Rate for Payer: Healthfirst QHP |
$28.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.23
|
| Rate for Payer: SOMOS Essential |
$21.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.31
|
|
|
PR INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y
|
Professional
|
Both
|
$344.30
|
|
|
Service Code
|
HCPCS 36555
|
| Min. Negotiated Rate |
$64.33 |
| Max. Negotiated Rate |
$206.78 |
| Rate for Payer: Cash Price |
$92.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.92
|
| Rate for Payer: Healthfirst Commercial |
$91.90
|
| Rate for Payer: Healthfirst Essential Plan |
$206.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.31
|
| Rate for Payer: Healthfirst QHP |
$91.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.92
|
| Rate for Payer: SOMOS Essential |
$68.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.90
|
|
|
PR INSJ OC IMPLT AFTER ENCL MUSC ATTACHED
|
Professional
|
Both
|
$3,898.90
|
|
|
Service Code
|
HCPCS 65140
|
| Min. Negotiated Rate |
$727.87 |
| Max. Negotiated Rate |
$2,339.57 |
| Rate for Payer: Cash Price |
$1,066.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,039.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$935.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$935.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$987.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,039.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$987.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,039.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,039.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$779.86
|
| Rate for Payer: Healthfirst Commercial |
$1,039.81
|
| Rate for Payer: Healthfirst Essential Plan |
$2,339.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$987.82
|
| Rate for Payer: Healthfirst QHP |
$1,039.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$727.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,039.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$883.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$727.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,039.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$779.86
|
| Rate for Payer: SOMOS Essential |
$779.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,039.81
|
|
|
PR INSJ OC IMPLT AFTER ENCL MUSC X ATTACHED
|
Professional
|
Both
|
$3,633.91
|
|
|
Service Code
|
HCPCS 65135
|
| Min. Negotiated Rate |
$676.93 |
| Max. Negotiated Rate |
$2,175.84 |
| Rate for Payer: Cash Price |
$993.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$967.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$870.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$870.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$918.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$967.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$918.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$967.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$967.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$725.28
|
| Rate for Payer: Healthfirst Commercial |
$967.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,175.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$918.69
|
| Rate for Payer: Healthfirst QHP |
$967.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$676.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$967.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$821.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$676.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$967.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$725.28
|
| Rate for Payer: SOMOS Essential |
$725.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$967.04
|
|
|
PR INSJ OC IMPLT SEC AFTER EVSC SCLL SHELL
|
Professional
|
Both
|
$3,592.79
|
|
|
Service Code
|
HCPCS 65130
|
| Min. Negotiated Rate |
$669.16 |
| Max. Negotiated Rate |
$2,150.89 |
| Rate for Payer: Cash Price |
$981.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$955.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$860.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$860.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$908.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$955.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$908.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$955.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$955.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$716.96
|
| Rate for Payer: Healthfirst Commercial |
$955.95
|
| Rate for Payer: Healthfirst Essential Plan |
$2,150.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$908.15
|
| Rate for Payer: Healthfirst QHP |
$955.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$669.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$955.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$812.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$669.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$955.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$716.96
|
| Rate for Payer: SOMOS Essential |
$716.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$955.95
|
|
|
PR INSJ OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Professional
|
Both
|
$1,998.33
|
|
|
Service Code
|
HCPCS 33271
|
| Min. Negotiated Rate |
$371.03 |
| Max. Negotiated Rate |
$1,192.59 |
| Rate for Payer: Cash Price |
$534.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$530.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$477.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$477.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$503.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$530.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$503.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$530.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$530.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$397.53
|
| Rate for Payer: Healthfirst Commercial |
$530.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,192.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$503.54
|
| Rate for Payer: Healthfirst QHP |
$530.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$371.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$530.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$450.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$371.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$530.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$397.53
|
| Rate for Payer: SOMOS Essential |
$397.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$530.04
|
|
|
PR INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID
|
Professional
|
Both
|
$2,235.80
|
|
|
Service Code
|
HCPCS 54400
|
| Min. Negotiated Rate |
$426.37 |
| Max. Negotiated Rate |
$1,370.47 |
| Rate for Payer: Cash Price |
$612.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$609.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$548.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$548.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$578.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$609.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$578.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$609.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$609.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$456.82
|
| Rate for Payer: Healthfirst Commercial |
$609.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,370.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$578.64
|
| Rate for Payer: Healthfirst QHP |
$609.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$426.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$609.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$517.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$426.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$609.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$456.82
|
| Rate for Payer: SOMOS Essential |
$456.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$609.10
|
|
|
PR INSJ PENILE PROSTHESOS INFLATABLE SELF-CONTAINED
|
Professional
|
Both
|
$2,798.18
|
|
|
Service Code
|
HCPCS 54401
|
| Min. Negotiated Rate |
$536.14 |
| Max. Negotiated Rate |
$1,723.32 |
| Rate for Payer: Cash Price |
$769.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$765.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$689.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$689.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$727.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$765.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$727.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$765.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$765.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$574.44
|
| Rate for Payer: Healthfirst Commercial |
$765.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,723.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$727.62
|
| Rate for Payer: Healthfirst QHP |
$765.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$536.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$765.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$651.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$536.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$765.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$574.44
|
| Rate for Payer: SOMOS Essential |
$574.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$765.92
|
|
|
PR INSJ PERQ VAD W/RS&I L HRT ARTERIAL ACCESS ONLY
|
Professional
|
Both
|
$1,586.34
|
|
|
Service Code
|
HCPCS 33990
|
| Min. Negotiated Rate |
$290.93 |
| Max. Negotiated Rate |
$935.12 |
| Rate for Payer: Cash Price |
$420.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$374.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$374.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$394.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$394.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$415.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$311.71
|
| Rate for Payer: Healthfirst Commercial |
$415.61
|
| Rate for Payer: Healthfirst Essential Plan |
$935.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$394.83
|
| Rate for Payer: Healthfirst QHP |
$415.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$290.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$415.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$353.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$290.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$311.71
|
| Rate for Payer: SOMOS Essential |
$311.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.61
|
|
|
PR INSJ PERQ VAD W/RS&I L HRT ARTERIAL&VEN ACCESS
|
Professional
|
Both
|
$2,003.75
|
|
|
Service Code
|
HCPCS 33991
|
| Min. Negotiated Rate |
$366.33 |
| Max. Negotiated Rate |
$1,177.49 |
| Rate for Payer: Cash Price |
$528.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$523.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$471.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$471.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$497.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$523.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$497.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$523.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$523.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$392.50
|
| Rate for Payer: Healthfirst Commercial |
$523.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,177.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$497.16
|
| Rate for Payer: Healthfirst QHP |
$523.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$366.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$523.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$444.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$366.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$523.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$392.50
|
| Rate for Payer: SOMOS Essential |
$392.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$523.33
|
|
|
PR INSJ PERQ VAD W/RS&I R HEART VENOUS ACCESS ONLY
|
Professional
|
Both
|
$1,541.54
|
|
|
Service Code
|
HCPCS 33995
|
| Min. Negotiated Rate |
$285.71 |
| Max. Negotiated Rate |
$918.36 |
| Rate for Payer: Cash Price |
$412.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$408.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$367.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$367.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$387.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$408.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$387.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$408.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$408.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$306.12
|
| Rate for Payer: Healthfirst Commercial |
$408.16
|
| Rate for Payer: Healthfirst Essential Plan |
$918.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$387.75
|
| Rate for Payer: Healthfirst QHP |
$408.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$285.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$408.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$346.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$285.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$408.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$306.12
|
| Rate for Payer: SOMOS Essential |
$306.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$408.16
|
|
