|
PR INSJ PIN-RETAINED PALATAL PROSTHESIS
|
Professional
|
Both
|
$680.93
|
|
|
Service Code
|
HCPCS 42281
|
| Min. Negotiated Rate |
$130.47 |
| Max. Negotiated Rate |
$419.36 |
| Rate for Payer: Cash Price |
$186.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$177.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$177.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.78
|
| Rate for Payer: Healthfirst Commercial |
$186.38
|
| Rate for Payer: Healthfirst Essential Plan |
$419.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$177.06
|
| Rate for Payer: Healthfirst QHP |
$186.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.78
|
| Rate for Payer: SOMOS Essential |
$139.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.38
|
|
|
PR INSJ PRPH CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$1,366.54
|
|
|
Service Code
|
HCPCS 36571
|
| Min. Negotiated Rate |
$254.41 |
| Max. Negotiated Rate |
$817.76 |
| Rate for Payer: Cash Price |
$367.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$363.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$327.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$327.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$345.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$363.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$345.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$363.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$363.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$272.59
|
| Rate for Payer: Healthfirst Commercial |
$363.45
|
| Rate for Payer: Healthfirst Essential Plan |
$817.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$345.28
|
| Rate for Payer: Healthfirst QHP |
$363.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$254.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$363.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$308.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$254.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$363.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$272.59
|
| Rate for Payer: SOMOS Essential |
$272.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$363.45
|
|
|
PR INSJ PRPH CTR VAD W/SUBQ PORT UNDER 5 YR
|
Professional
|
Both
|
$1,493.38
|
|
|
Service Code
|
HCPCS 36570
|
| Min. Negotiated Rate |
$277.56 |
| Max. Negotiated Rate |
$892.17 |
| Rate for Payer: Cash Price |
$399.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$396.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$356.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$356.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$376.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$396.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$376.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.39
|
| Rate for Payer: Healthfirst Commercial |
$396.52
|
| Rate for Payer: Healthfirst Essential Plan |
$892.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$376.69
|
| Rate for Payer: Healthfirst QHP |
$396.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$277.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$396.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$337.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$277.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$396.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.39
|
| Rate for Payer: SOMOS Essential |
$297.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$396.52
|
|
|
PR INSJ/RPLCMT BREAST IMPLANT SEP DAY MASTECTOMY
|
Professional
|
Both
|
$3,333.09
|
|
|
Service Code
|
HCPCS 19342
|
| Min. Negotiated Rate |
$627.89 |
| Max. Negotiated Rate |
$2,018.20 |
| Rate for Payer: Cash Price |
$900.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$896.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$807.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$807.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$852.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$896.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$852.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$896.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$896.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$672.74
|
| Rate for Payer: Healthfirst Commercial |
$896.98
|
| Rate for Payer: Healthfirst Essential Plan |
$2,018.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$852.13
|
| Rate for Payer: Healthfirst QHP |
$896.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$627.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$896.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$762.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$627.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$896.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$672.74
|
| Rate for Payer: SOMOS Essential |
$672.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$896.98
|
|
|
PR INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS
|
Professional
|
Both
|
$4,161.08
|
|
|
Service Code
|
HCPCS 61886
|
| Min. Negotiated Rate |
$774.06 |
| Max. Negotiated Rate |
$2,488.05 |
| Rate for Payer: Cash Price |
$1,113.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,105.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$995.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$995.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,050.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,105.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,050.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,105.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,105.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$829.35
|
| Rate for Payer: Healthfirst Commercial |
$1,105.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,488.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,050.51
|
| Rate for Payer: Healthfirst QHP |
$1,105.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$774.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,105.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$939.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$774.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,105.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$829.35
|
| Rate for Payer: SOMOS Essential |
$829.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,105.80
|
|
|
PR INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR
|
Professional
|
Both
|
$2,491.83
|
|
|
Service Code
|
HCPCS 61885
|
| Min. Negotiated Rate |
$462.82 |
| Max. Negotiated Rate |
$1,487.63 |
| Rate for Payer: Cash Price |
$665.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$661.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$595.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$595.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$628.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$661.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$628.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$661.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$661.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$495.88
|
| Rate for Payer: Healthfirst Commercial |
$661.17
|
| Rate for Payer: Healthfirst Essential Plan |
$1,487.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$628.11
|
| Rate for Payer: Healthfirst QHP |
$661.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$462.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$661.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$561.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$462.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$661.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$495.88
|
| Rate for Payer: SOMOS Essential |
$495.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$661.17
|
|
|
PR INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR
|
Professional
|
Both
|
$4,035.05
|
|
|
Service Code
|
HCPCS 33249
|
| Min. Negotiated Rate |
$739.93 |
| Max. Negotiated Rate |
$2,378.34 |
| Rate for Payer: Cash Price |
$1,068.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,057.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$951.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$951.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,004.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,057.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,004.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,057.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,057.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$792.78
|
| Rate for Payer: Healthfirst Commercial |
$1,057.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,378.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,004.19
|
| Rate for Payer: Healthfirst QHP |
$1,057.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$739.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,057.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$898.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$739.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,057.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$792.78
|
| Rate for Payer: SOMOS Essential |
$792.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,057.04
|
|
|
PR INSJ/RPLCMT SPINAL NPG/RCVR POCKET CRTJ&CONNJ
|
Professional
|
Both
|
$1,606.36
|
|
|
Service Code
|
HCPCS 63685
|
| Min. Negotiated Rate |
$280.36 |
| Max. Negotiated Rate |
$901.15 |
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$400.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$360.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$360.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$380.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$400.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$380.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$300.38
|
| Rate for Payer: Healthfirst Commercial |
$400.51
|
| Rate for Payer: Healthfirst Essential Plan |
$901.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$380.48
|
| Rate for Payer: Healthfirst QHP |
$400.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$280.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$400.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$340.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$280.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$400.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$300.38
|
| Rate for Payer: SOMOS Essential |
$300.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$400.51
|
|
|
PR INSJ/RPLCMT TEMP TRANSVNS 1CHMBR ELTRD/PM CATH
|
Professional
|
Both
|
$708.05
|
|
|
Service Code
|
HCPCS 33210
|
| Min. Negotiated Rate |
$129.61 |
| Max. Negotiated Rate |
$416.61 |
| Rate for Payer: Cash Price |
$186.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.87
|
| Rate for Payer: Healthfirst Commercial |
$185.16
|
| Rate for Payer: Healthfirst Essential Plan |
$416.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.90
|
| Rate for Payer: Healthfirst QHP |
$185.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.87
|
| Rate for Payer: SOMOS Essential |
$138.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.16
|
|
|
PR INSJ/RPLCMT TEMP TRANSVNS 2CHMBR PACG ELTRDS SPX
|
Professional
|
Both
|
$736.30
|
|
|
Service Code
|
HCPCS 33211
|
| Min. Negotiated Rate |
$134.55 |
| Max. Negotiated Rate |
$432.47 |
| Rate for Payer: Cash Price |
$195.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$182.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.16
|
| Rate for Payer: Healthfirst Commercial |
$192.21
|
| Rate for Payer: Healthfirst Essential Plan |
$432.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$182.60
|
| Rate for Payer: Healthfirst QHP |
$192.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$192.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$163.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.16
|
| Rate for Payer: SOMOS Essential |
$144.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.21
|
|
|
PR INSJ RX ELUTING IMPLT PUNCTAL DILAT LAC CANAL EA
|
Professional
|
Both
|
$134.12
|
|
|
Service Code
|
HCPCS 68841
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$81.97 |
| Rate for Payer: Cash Price |
$36.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.32
|
| Rate for Payer: Healthfirst Commercial |
$36.43
|
| Rate for Payer: Healthfirst Essential Plan |
$81.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.61
|
| Rate for Payer: Healthfirst QHP |
$36.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.32
|
| Rate for Payer: SOMOS Essential |
$27.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.43
|
|
|
PR INSJ STABLJ DEV W/DCMPRN LUMBAR SECOND LEVEL
|
Professional
|
Both
|
$1,135.86
|
|
|
Service Code
|
HCPCS 22868
|
| Min. Negotiated Rate |
$205.32 |
| Max. Negotiated Rate |
$659.95 |
| Rate for Payer: Cash Price |
$297.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$278.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$278.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$293.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$219.98
|
| Rate for Payer: Healthfirst Commercial |
$293.31
|
| Rate for Payer: Healthfirst Essential Plan |
$659.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$278.64
|
| Rate for Payer: Healthfirst QHP |
$293.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$205.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$293.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$249.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$205.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$219.98
|
| Rate for Payer: SOMOS Essential |
$219.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.31
|
|
|
PR INSJ STABLJ DEV W/DCMPRN LUMBAR SINGLE LEVEL
|
Professional
|
Both
|
$4,992.68
|
|
|
Service Code
|
HCPCS 22867
|
| Min. Negotiated Rate |
$902.99 |
| Max. Negotiated Rate |
$2,902.48 |
| Rate for Payer: Cash Price |
$1,319.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,289.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,160.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,160.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,225.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,289.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,225.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,289.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,289.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$967.49
|
| Rate for Payer: Healthfirst Commercial |
$1,289.99
|
| Rate for Payer: Healthfirst Essential Plan |
$2,902.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,225.49
|
| Rate for Payer: Healthfirst QHP |
$1,289.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$902.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,289.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,096.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$902.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,289.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$967.49
|
| Rate for Payer: SOMOS Essential |
$967.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,289.99
|
|
|
PR INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL
|
Professional
|
Both
|
$486.96
|
|
|
Service Code
|
HCPCS 22870
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$293.20 |
| Rate for Payer: Cash Price |
$132.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.73
|
| Rate for Payer: Healthfirst Commercial |
$130.31
|
| Rate for Payer: Healthfirst Essential Plan |
$293.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$123.79
|
| Rate for Payer: Healthfirst QHP |
$130.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.73
|
| Rate for Payer: SOMOS Essential |
$97.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.31
|
|
|
PR INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL
|
Professional
|
Both
|
$1,804.11
|
|
|
Service Code
|
HCPCS 22869
|
| Min. Negotiated Rate |
$342.79 |
| Max. Negotiated Rate |
$1,101.83 |
| Rate for Payer: Cash Price |
$496.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$489.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$440.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$440.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$465.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$489.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$465.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$489.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$489.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$367.27
|
| Rate for Payer: Healthfirst Commercial |
$489.70
|
| Rate for Payer: Healthfirst Essential Plan |
$1,101.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$465.21
|
| Rate for Payer: Healthfirst QHP |
$489.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$342.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$489.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$416.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$342.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$489.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$367.27
|
| Rate for Payer: SOMOS Essential |
$367.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$489.70
|
|
|
PR INSJ SUBQ EXTENSION INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$532.91
|
|
|
Service Code
|
HCPCS 49435
|
| Min. Negotiated Rate |
$98.64 |
| Max. Negotiated Rate |
$317.07 |
| Rate for Payer: Cash Price |
$140.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.69
|
| Rate for Payer: Healthfirst Commercial |
$140.92
|
| Rate for Payer: Healthfirst Essential Plan |
$317.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$140.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.69
|
| Rate for Payer: SOMOS Essential |
$105.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.92
|
|
|
PR INSJ SUBQ RSVR PUMP/INFUSION SYSTEM VENTRIC CATH
|
Professional
|
Both
|
$2,453.68
|
|
|
Service Code
|
HCPCS 61215
|
| Min. Negotiated Rate |
$456.31 |
| Max. Negotiated Rate |
$1,466.71 |
| Rate for Payer: Cash Price |
$655.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$651.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$586.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$586.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$619.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$651.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$619.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$651.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$651.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$488.90
|
| Rate for Payer: Healthfirst Commercial |
$651.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,466.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$619.28
|
| Rate for Payer: Healthfirst QHP |
$651.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$456.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$651.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$554.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$456.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$651.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$488.90
|
| Rate for Payer: SOMOS Essential |
$488.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$651.87
|
|
|
PR INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED
|
Professional
|
Both
|
$319.62
|
|
|
Service Code
|
HCPCS 51703
|
| Min. Negotiated Rate |
$59.92 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Cash Price |
$86.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.20
|
| Rate for Payer: Healthfirst Commercial |
$85.60
|
| Rate for Payer: Healthfirst Essential Plan |
$192.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.32
|
| Rate for Payer: Healthfirst QHP |
$85.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.20
|
| Rate for Payer: SOMOS Essential |
$64.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.60
|
|
|
PR INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE
|
Professional
|
Both
|
$104.93
|
|
|
Service Code
|
HCPCS 51702
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$62.30 |
| Rate for Payer: Cash Price |
$28.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.77
|
| Rate for Payer: Healthfirst Commercial |
$27.69
|
| Rate for Payer: Healthfirst Essential Plan |
$62.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.31
|
| Rate for Payer: Healthfirst QHP |
$27.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.77
|
| Rate for Payer: SOMOS Essential |
$20.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.69
|
|
|
PR INSJ TESTICULAR PROSTH SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,508.89
|
|
|
Service Code
|
HCPCS 54660
|
| Min. Negotiated Rate |
$290.32 |
| Max. Negotiated Rate |
$933.16 |
| Rate for Payer: Cash Price |
$415.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$414.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$373.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$394.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$414.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$394.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$414.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$414.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$311.06
|
| Rate for Payer: Healthfirst Commercial |
$414.74
|
| Rate for Payer: Healthfirst Essential Plan |
$933.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$394.00
|
| Rate for Payer: Healthfirst QHP |
$414.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$290.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$414.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$352.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$290.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$414.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$311.06
|
| Rate for Payer: SOMOS Essential |
$311.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$414.74
|
|
|
PR INSJ TRANSVNS INTRAHEPATC PORTOSYSIC SHUNT
|
Professional
|
Both
|
$3,322.13
|
|
|
Service Code
|
HCPCS 37182
|
| Min. Negotiated Rate |
$623.52 |
| Max. Negotiated Rate |
$2,004.16 |
| Rate for Payer: Cash Price |
$894.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$890.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$801.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$801.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$846.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$890.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$846.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$890.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$890.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$668.05
|
| Rate for Payer: Healthfirst Commercial |
$890.74
|
| Rate for Payer: Healthfirst Essential Plan |
$2,004.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$846.20
|
| Rate for Payer: Healthfirst QHP |
$890.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$623.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$890.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$757.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$623.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$890.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$668.05
|
| Rate for Payer: SOMOS Essential |
$668.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$890.74
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>
|
Professional
|
Both
|
$1,425.13
|
|
|
Service Code
|
HCPCS 36561
|
| Min. Negotiated Rate |
$264.47 |
| Max. Negotiated Rate |
$850.10 |
| Rate for Payer: Cash Price |
$382.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$377.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$340.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$340.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$358.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$377.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$358.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$283.37
|
| Rate for Payer: Healthfirst Commercial |
$377.82
|
| Rate for Payer: Healthfirst Essential Plan |
$850.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$358.93
|
| Rate for Payer: Healthfirst QHP |
$377.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$264.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$377.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$321.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$264.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$377.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$283.37
|
| Rate for Payer: SOMOS Essential |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.82
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PORT UNDER 5 YR
|
Professional
|
Both
|
$1,728.58
|
|
|
Service Code
|
HCPCS 36560
|
| Min. Negotiated Rate |
$320.31 |
| Max. Negotiated Rate |
$1,029.58 |
| Rate for Payer: Cash Price |
$460.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$457.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$411.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$411.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$457.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$457.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$457.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$343.19
|
| Rate for Payer: Healthfirst Commercial |
$457.59
|
| Rate for Payer: Healthfirst Essential Plan |
$1,029.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$434.71
|
| Rate for Payer: Healthfirst QHP |
$457.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$320.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$457.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$388.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$320.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$457.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$343.19
|
| Rate for Payer: SOMOS Essential |
$343.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$457.59
|
|
|
PR INSJ TUNNELED CTR VAD W/SUBQ PUMP
|
Professional
|
Both
|
$1,609.06
|
|
|
Service Code
|
HCPCS 36563
|
| Min. Negotiated Rate |
$296.18 |
| Max. Negotiated Rate |
$952.00 |
| Rate for Payer: Cash Price |
$423.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$423.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$380.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$380.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$401.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$423.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$401.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$423.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$423.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$317.33
|
| Rate for Payer: Healthfirst Commercial |
$423.11
|
| Rate for Payer: Healthfirst Essential Plan |
$952.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$401.95
|
| Rate for Payer: Healthfirst QHP |
$423.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$296.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$423.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$359.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$296.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$423.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$317.33
|
| Rate for Payer: SOMOS Essential |
$317.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$423.11
|
|
|
PR INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>
|
Professional
|
Both
|
$1,099.18
|
|
|
Service Code
|
HCPCS 36558
|
| Min. Negotiated Rate |
$204.78 |
| Max. Negotiated Rate |
$658.24 |
| Rate for Payer: Cash Price |
$294.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$292.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$277.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$292.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$277.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$292.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$292.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$219.41
|
| Rate for Payer: Healthfirst Commercial |
$292.55
|
| Rate for Payer: Healthfirst Essential Plan |
$658.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$277.92
|
| Rate for Payer: Healthfirst QHP |
$292.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$204.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$292.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$248.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$204.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$292.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$219.41
|
| Rate for Payer: SOMOS Essential |
$219.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.55
|
|
