|
PR REMOVAL TUMOR TEMPORAL BONE
|
Professional
|
Both
|
$9,179.03
|
|
|
Service Code
|
HCPCS 69970
|
| Min. Negotiated Rate |
$1,706.63 |
| Max. Negotiated Rate |
$5,485.61 |
| Rate for Payer: Cash Price |
$2,474.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,438.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,194.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,194.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,316.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,438.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,316.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,438.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,438.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,828.54
|
| Rate for Payer: Healthfirst Commercial |
$2,438.05
|
| Rate for Payer: Healthfirst Essential Plan |
$5,485.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,316.15
|
| Rate for Payer: Healthfirst QHP |
$2,438.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,706.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,438.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,072.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,706.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,438.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,828.54
|
| Rate for Payer: SOMOS Essential |
$1,828.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,438.05
|
|
|
PR REMOVAL TUNNELED INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$985.74
|
|
|
Service Code
|
HCPCS 49422
|
| Min. Negotiated Rate |
$181.64 |
| Max. Negotiated Rate |
$583.85 |
| Rate for Payer: Cash Price |
$262.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$259.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$233.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$233.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$246.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$259.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$246.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$259.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$259.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.62
|
| Rate for Payer: Healthfirst Commercial |
$259.49
|
| Rate for Payer: Healthfirst Essential Plan |
$583.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.52
|
| Rate for Payer: Healthfirst QHP |
$259.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$181.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$259.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$220.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$181.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$259.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$194.62
|
| Rate for Payer: SOMOS Essential |
$194.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$259.49
|
|
|
PR REMOVAL VENTR ASSIST DEVICE XTRCORP 1 VENTRICLE
|
Professional
|
Both
|
$4,944.63
|
|
|
Service Code
|
HCPCS 33977
|
| Min. Negotiated Rate |
$914.80 |
| Max. Negotiated Rate |
$2,940.43 |
| Rate for Payer: Cash Price |
$1,314.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,306.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,176.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,176.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,241.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,306.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,241.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,306.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,306.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$980.14
|
| Rate for Payer: Healthfirst Commercial |
$1,306.86
|
| Rate for Payer: Healthfirst Essential Plan |
$2,940.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,241.52
|
| Rate for Payer: Healthfirst QHP |
$1,306.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$914.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,306.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,110.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$914.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,306.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$980.14
|
| Rate for Payer: SOMOS Essential |
$980.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,306.86
|
|
|
PR REMOVAL VENTR ASSIST DEVICE XTRCORP BIVENTR
|
Professional
|
Both
|
$5,846.12
|
|
|
Service Code
|
HCPCS 33978
|
| Min. Negotiated Rate |
$1,075.50 |
| Max. Negotiated Rate |
$3,456.97 |
| Rate for Payer: Cash Price |
$1,548.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,536.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,382.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,382.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,459.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,536.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,459.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,536.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,536.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,152.32
|
| Rate for Payer: Healthfirst Commercial |
$1,536.43
|
| Rate for Payer: Healthfirst Essential Plan |
$3,456.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,459.61
|
| Rate for Payer: Healthfirst QHP |
$1,536.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,075.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,536.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,305.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,075.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,536.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,152.32
|
| Rate for Payer: SOMOS Essential |
$1,152.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,536.43
|
|
|
PR REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST
|
Professional
|
Both
|
$3,196.41
|
|
|
Service Code
|
HCPCS 25251
|
| Min. Negotiated Rate |
$602.66 |
| Max. Negotiated Rate |
$1,937.12 |
| Rate for Payer: Cash Price |
$865.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$860.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$774.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$774.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$817.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$860.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$817.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$860.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$860.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$645.71
|
| Rate for Payer: Healthfirst Commercial |
$860.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,937.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$817.89
|
| Rate for Payer: Healthfirst QHP |
$860.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$602.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$860.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$731.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$602.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$860.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$645.71
|
| Rate for Payer: SOMOS Essential |
$645.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$860.94
|
|
|
PR REMOVAL WRIST PROSTHESIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,373.21
|
|
|
Service Code
|
HCPCS 25250
|
| Min. Negotiated Rate |
$450.55 |
| Max. Negotiated Rate |
$1,448.19 |
| Rate for Payer: Cash Price |
$645.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$643.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$579.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$579.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$611.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$643.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$611.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$643.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$643.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$482.73
|
| Rate for Payer: Healthfirst Commercial |
$643.64
|
| Rate for Payer: Healthfirst Essential Plan |
$1,448.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$611.46
|
| Rate for Payer: Healthfirst QHP |
$643.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$450.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$643.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$547.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$450.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$643.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$482.73
|
| Rate for Payer: SOMOS Essential |
$482.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$643.64
|
|
|
PR REMOVE DRUG IMPLANT
|
Professional
|
Both
|
$443.91
|
|
|
Service Code
|
HCPCS G0517
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$272.56 |
| Rate for Payer: Cash Price |
$122.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$121.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$121.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.86
|
| Rate for Payer: Healthfirst Commercial |
$121.14
|
| Rate for Payer: Healthfirst Essential Plan |
$272.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$115.08
|
| Rate for Payer: Healthfirst QHP |
$121.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$121.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$121.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.86
|
| Rate for Payer: SOMOS Essential |
$90.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.14
|
|
|
PR REMOVE INT DWELL URETERAL STENT TRANSURETHRAL
|
Professional
|
Both
|
$671.69
|
|
|
Service Code
|
HCPCS 50386
|
| Min. Negotiated Rate |
$128.30 |
| Max. Negotiated Rate |
$412.40 |
| Rate for Payer: Cash Price |
$183.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$183.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$164.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$183.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$174.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$183.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.47
|
| Rate for Payer: Healthfirst Commercial |
$183.29
|
| Rate for Payer: Healthfirst Essential Plan |
$412.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$174.13
|
| Rate for Payer: Healthfirst QHP |
$183.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$183.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$155.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$183.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.47
|
| Rate for Payer: SOMOS Essential |
$137.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$183.29
|
|
|
PR REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL
|
Professional
|
Both
|
$893.45
|
|
|
Service Code
|
HCPCS 50385
|
| Min. Negotiated Rate |
$168.87 |
| Max. Negotiated Rate |
$542.79 |
| Rate for Payer: Cash Price |
$240.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$241.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$217.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$217.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$229.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$241.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$229.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$241.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$241.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.93
|
| Rate for Payer: Healthfirst Commercial |
$241.24
|
| Rate for Payer: Healthfirst Essential Plan |
$542.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$229.18
|
| Rate for Payer: Healthfirst QHP |
$241.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$168.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$241.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$205.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$168.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$241.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$180.93
|
| Rate for Payer: SOMOS Essential |
$180.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$241.24
|
|
|
PR REMOVE W INSERT DRUG IMPLANT
|
Professional
|
Both
|
$727.93
|
|
|
Service Code
|
HCPCS G0518
|
| Min. Negotiated Rate |
$138.44 |
| Max. Negotiated Rate |
$444.98 |
| Rate for Payer: Cash Price |
$199.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$187.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$187.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.33
|
| Rate for Payer: Healthfirst Commercial |
$197.77
|
| Rate for Payer: Healthfirst Essential Plan |
$444.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$187.88
|
| Rate for Payer: Healthfirst QHP |
$197.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$197.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$168.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$148.33
|
| Rate for Payer: SOMOS Essential |
$148.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.77
|
|
|
PR REM THER MNTR DEV SPLY W/REC MUSCSKEL SYS EA 30D
|
Professional
|
Both
|
$214.06
|
|
|
Service Code
|
HCPCS 98977
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.66 |
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.89
|
| Rate for Payer: Healthfirst Commercial |
$51.85
|
| Rate for Payer: Healthfirst Essential Plan |
$116.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.26
|
| Rate for Payer: Healthfirst QHP |
$51.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.89
|
| Rate for Payer: SOMOS Essential |
$38.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.85
|
|
|
PR REM THER MNTR DEV SUPPLY W/REC RESPIR SYS EA 30D
|
Professional
|
Both
|
$214.06
|
|
|
Service Code
|
HCPCS 98976
|
| Min. Negotiated Rate |
$36.30 |
| Max. Negotiated Rate |
$116.66 |
| Rate for Payer: Cash Price |
$56.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.89
|
| Rate for Payer: Healthfirst Commercial |
$51.85
|
| Rate for Payer: Healthfirst Essential Plan |
$116.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.26
|
| Rate for Payer: Healthfirst QHP |
$51.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.89
|
| Rate for Payer: SOMOS Essential |
$38.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.85
|
|
|
PR REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Professional
|
Both
|
$2,696.05
|
|
|
Service Code
|
HCPCS 53446
|
| Min. Negotiated Rate |
$514.73 |
| Max. Negotiated Rate |
$1,654.49 |
| Rate for Payer: Cash Price |
$739.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$735.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$661.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$661.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$698.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$735.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$698.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$735.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$551.50
|
| Rate for Payer: Healthfirst Commercial |
$735.33
|
| Rate for Payer: Healthfirst Essential Plan |
$1,654.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$698.56
|
| Rate for Payer: Healthfirst QHP |
$735.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$514.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$735.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$625.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$514.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$735.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$551.50
|
| Rate for Payer: SOMOS Essential |
$551.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$735.33
|
|
|
PR REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD
|
Professional
|
Both
|
$1,498.07
|
|
|
Service Code
|
HCPCS 33227
|
| Min. Negotiated Rate |
$276.02 |
| Max. Negotiated Rate |
$887.20 |
| Rate for Payer: Cash Price |
$399.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$394.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$354.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$354.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$374.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$394.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$374.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$394.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$394.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$295.73
|
| Rate for Payer: Healthfirst Commercial |
$394.31
|
| Rate for Payer: Healthfirst Essential Plan |
$887.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$374.59
|
| Rate for Payer: Healthfirst QHP |
$394.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$276.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$394.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$335.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$276.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$394.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$295.73
|
| Rate for Payer: SOMOS Essential |
$295.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$394.31
|
|
|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS
|
Professional
|
Both
|
$1,561.49
|
|
|
Service Code
|
HCPCS 33228
|
| Min. Negotiated Rate |
$289.25 |
| Max. Negotiated Rate |
$929.75 |
| Rate for Payer: Cash Price |
$416.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$413.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$371.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$371.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$392.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$413.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$392.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$413.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$413.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$309.92
|
| Rate for Payer: Healthfirst Commercial |
$413.22
|
| Rate for Payer: Healthfirst Essential Plan |
$929.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$392.56
|
| Rate for Payer: Healthfirst QHP |
$413.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$289.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$413.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$351.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$289.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$413.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$309.92
|
| Rate for Payer: SOMOS Essential |
$309.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$413.22
|
|
|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD
|
Professional
|
Both
|
$1,651.86
|
|
|
Service Code
|
HCPCS 33229
|
| Min. Negotiated Rate |
$302.93 |
| Max. Negotiated Rate |
$973.69 |
| Rate for Payer: Cash Price |
$437.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$432.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$389.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$389.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$411.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$432.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$411.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.56
|
| Rate for Payer: Healthfirst Commercial |
$432.75
|
| Rate for Payer: Healthfirst Essential Plan |
$973.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$411.11
|
| Rate for Payer: Healthfirst QHP |
$432.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$302.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$432.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$367.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$302.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$432.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$324.56
|
| Rate for Payer: SOMOS Essential |
$324.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$432.75
|
|
|
PR RENAL ALTRNSPLJ IMPLTJ GRF W/O RCP NEPHRECTOMY
|
Professional
|
Both
|
$10,931.03
|
|
|
Service Code
|
HCPCS 50360
|
| Min. Negotiated Rate |
$2,034.96 |
| Max. Negotiated Rate |
$6,540.95 |
| Rate for Payer: Cash Price |
$2,926.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,907.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,616.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,616.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,761.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,907.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,761.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,907.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,907.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,180.32
|
| Rate for Payer: Healthfirst Commercial |
$2,907.09
|
| Rate for Payer: Healthfirst Essential Plan |
$6,540.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,761.74
|
| Rate for Payer: Healthfirst QHP |
$2,907.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,034.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,907.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,471.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,034.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,907.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,180.32
|
| Rate for Payer: SOMOS Essential |
$2,180.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,907.09
|
|
|
PR RENAL ALTRNSPLJ IMPLTJ GRF W/RCP NEPHRECTOMY
|
Professional
|
Both
|
$12,988.54
|
|
|
Service Code
|
HCPCS 50365
|
| Min. Negotiated Rate |
$2,426.33 |
| Max. Negotiated Rate |
$7,798.90 |
| Rate for Payer: Cash Price |
$3,488.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,466.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,119.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,119.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,292.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,466.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,292.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,466.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,466.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,599.64
|
| Rate for Payer: Healthfirst Commercial |
$3,466.18
|
| Rate for Payer: Healthfirst Essential Plan |
$7,798.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,292.87
|
| Rate for Payer: Healthfirst QHP |
$3,466.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,426.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,466.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,946.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,426.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,466.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,599.64
|
| Rate for Payer: SOMOS Essential |
$2,599.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,466.18
|
|
|
PR RENAL AUTOTRNSPLJ REIMPLANTATION KIDNEY
|
Professional
|
Both
|
$9,184.98
|
|
|
Service Code
|
HCPCS 50380
|
| Min. Negotiated Rate |
$1,717.56 |
| Max. Negotiated Rate |
$5,520.73 |
| Rate for Payer: Cash Price |
$2,465.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,453.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,208.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,208.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,330.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,453.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,330.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,453.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,453.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,840.24
|
| Rate for Payer: Healthfirst Commercial |
$2,453.66
|
| Rate for Payer: Healthfirst Essential Plan |
$5,520.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,330.98
|
| Rate for Payer: Healthfirst QHP |
$2,453.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,717.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,453.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,085.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,717.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,453.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,840.24
|
| Rate for Payer: SOMOS Essential |
$1,840.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,453.66
|
|
|
PR RENAL BIOPSY PRQ TROCAR/NEEDLE
|
Professional
|
Both
|
$519.16
|
|
|
Service Code
|
HCPCS 50200
|
| Min. Negotiated Rate |
$98.05 |
| Max. Negotiated Rate |
$315.16 |
| Rate for Payer: Cash Price |
$141.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.05
|
| Rate for Payer: Healthfirst Commercial |
$140.07
|
| Rate for Payer: Healthfirst Essential Plan |
$315.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.07
|
| Rate for Payer: Healthfirst QHP |
$140.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.05
|
| Rate for Payer: SOMOS Essential |
$105.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.07
|
|
|
PR RENAL BIOPSY SURG EXPOSURE KIDNEY
|
Professional
|
Both
|
$3,384.15
|
|
|
Service Code
|
HCPCS 50205
|
| Min. Negotiated Rate |
$629.98 |
| Max. Negotiated Rate |
$2,024.93 |
| Rate for Payer: Cash Price |
$906.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$899.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$809.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$809.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$854.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$899.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$854.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$899.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$899.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$674.98
|
| Rate for Payer: Healthfirst Commercial |
$899.97
|
| Rate for Payer: Healthfirst Essential Plan |
$2,024.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$854.97
|
| Rate for Payer: Healthfirst QHP |
$899.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$629.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$899.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$764.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$629.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$899.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$674.98
|
| Rate for Payer: SOMOS Essential |
$674.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$899.97
|
|
|
PR RENAL ENDOSCOPY NEPHROSTOMY W/WO IRRIGATION
|
Professional
|
Both
|
$1,219.82
|
|
|
Service Code
|
HCPCS 50551
|
| Min. Negotiated Rate |
$230.63 |
| Max. Negotiated Rate |
$741.31 |
| Rate for Payer: Cash Price |
$331.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$329.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$296.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$296.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$313.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$313.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$329.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$329.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$247.10
|
| Rate for Payer: Healthfirst Commercial |
$329.47
|
| Rate for Payer: Healthfirst Essential Plan |
$741.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$313.00
|
| Rate for Payer: Healthfirst QHP |
$329.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$230.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$329.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$280.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$230.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$329.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$247.10
|
| Rate for Payer: SOMOS Essential |
$247.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$329.47
|
|
|
PR RENAL NDSC NEPHROS/PYELOSTOMY BIOPSY
|
Professional
|
Both
|
$1,412.43
|
|
|
Service Code
|
HCPCS 50555
|
| Min. Negotiated Rate |
$268.19 |
| Max. Negotiated Rate |
$862.04 |
| Rate for Payer: Cash Price |
$384.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$383.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$344.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$344.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$363.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$383.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$363.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$287.35
|
| Rate for Payer: Healthfirst Commercial |
$383.13
|
| Rate for Payer: Healthfirst Essential Plan |
$862.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$363.97
|
| Rate for Payer: Healthfirst QHP |
$383.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$268.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$383.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$325.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$268.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$383.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$287.35
|
| Rate for Payer: SOMOS Essential |
$287.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$383.13
|
|
|
PR RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BI
|
Professional
|
Both
|
$1,430.73
|
|
|
Service Code
|
HCPCS 50557
|
| Min. Negotiated Rate |
$271.18 |
| Max. Negotiated Rate |
$871.65 |
| Rate for Payer: Cash Price |
$389.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$387.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$348.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$348.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$368.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$387.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$368.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$387.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$387.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$290.55
|
| Rate for Payer: Healthfirst Commercial |
$387.40
|
| Rate for Payer: Healthfirst Essential Plan |
$871.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$368.03
|
| Rate for Payer: Healthfirst QHP |
$387.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$271.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$387.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$329.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$271.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$387.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$290.55
|
| Rate for Payer: SOMOS Essential |
$290.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$387.40
|
|
|
PR RENAL NDSC NEPHROS/PYELOSTOMY RESCJ TUMOR
|
Professional
|
Both
|
$2,395.23
|
|
|
Service Code
|
HCPCS 50562
|
| Min. Negotiated Rate |
$454.57 |
| Max. Negotiated Rate |
$1,461.13 |
| Rate for Payer: Cash Price |
$653.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$649.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$584.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$584.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$616.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$649.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$616.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$649.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$649.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$487.04
|
| Rate for Payer: Healthfirst Commercial |
$649.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,461.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$616.92
|
| Rate for Payer: Healthfirst QHP |
$649.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$454.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$649.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$551.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$454.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$649.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$487.04
|
| Rate for Payer: SOMOS Essential |
$487.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$649.39
|
|
