|
PR RMVL LEFT HEART VENT BY THORACIC INCIS ECMO/ECLS
|
Professional
|
Both
|
$2,166.40
|
|
|
Service Code
|
HCPCS 33989
|
| Min. Negotiated Rate |
$396.45 |
| Max. Negotiated Rate |
$1,274.31 |
| Rate for Payer: Cash Price |
$573.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$566.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$509.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$509.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$538.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$566.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$538.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$566.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$424.77
|
| Rate for Payer: Healthfirst Commercial |
$566.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,274.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$538.04
|
| Rate for Payer: Healthfirst QHP |
$566.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$396.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$566.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$481.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$396.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$566.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$424.77
|
| Rate for Payer: SOMOS Essential |
$424.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$566.36
|
|
|
PR RMVL LENS MATERIAL ASPIR TQ 1/> STAGES
|
Professional
|
Both
|
$2,850.54
|
|
|
Service Code
|
HCPCS 66840
|
| Min. Negotiated Rate |
$541.46 |
| Max. Negotiated Rate |
$1,740.42 |
| Rate for Payer: Cash Price |
$784.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$773.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$696.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$696.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$734.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$773.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$734.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$773.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$773.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$580.14
|
| Rate for Payer: Healthfirst Commercial |
$773.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,740.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$734.84
|
| Rate for Payer: Healthfirst QHP |
$773.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$541.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$773.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$657.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$541.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$773.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$580.14
|
| Rate for Payer: SOMOS Essential |
$580.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$773.52
|
|
|
PR RMVL LENS MATERIAL INTRACAPSULAR
|
Professional
|
Both
|
$3,077.80
|
|
|
Service Code
|
HCPCS 66920
|
| Min. Negotiated Rate |
$585.38 |
| Max. Negotiated Rate |
$1,881.59 |
| Rate for Payer: Cash Price |
$846.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$836.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$752.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$752.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$794.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$836.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$794.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$836.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$836.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$627.20
|
| Rate for Payer: Healthfirst Commercial |
$836.26
|
| Rate for Payer: Healthfirst Essential Plan |
$1,881.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$794.45
|
| Rate for Payer: Healthfirst QHP |
$836.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$585.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$836.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$710.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$585.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$836.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$627.20
|
| Rate for Payer: SOMOS Essential |
$627.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$836.26
|
|
|
PR RMVL LENS MATERIAL PARS PLANA W/WO VITRECTOMY
|
Professional
|
Both
|
$3,445.16
|
|
|
Service Code
|
HCPCS 66852
|
| Min. Negotiated Rate |
$654.22 |
| Max. Negotiated Rate |
$2,102.85 |
| Rate for Payer: Cash Price |
$948.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$934.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$841.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$841.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$887.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$934.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$887.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$934.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$934.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$700.95
|
| Rate for Payer: Healthfirst Commercial |
$934.60
|
| Rate for Payer: Healthfirst Essential Plan |
$2,102.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$887.87
|
| Rate for Payer: Healthfirst QHP |
$934.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$654.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$934.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$794.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$654.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$934.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$700.95
|
| Rate for Payer: SOMOS Essential |
$700.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$934.60
|
|
|
PR RMVL LENS MATERIAL PHACOFRAGMENTATION ASPIR
|
Professional
|
Both
|
$3,237.92
|
|
|
Service Code
|
HCPCS 66850
|
| Min. Negotiated Rate |
$615.94 |
| Max. Negotiated Rate |
$1,979.80 |
| Rate for Payer: Cash Price |
$891.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$879.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$791.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$791.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$835.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$879.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$835.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$879.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$879.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$659.93
|
| Rate for Payer: Healthfirst Commercial |
$879.91
|
| Rate for Payer: Healthfirst Essential Plan |
$1,979.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$835.91
|
| Rate for Payer: Healthfirst QHP |
$879.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$615.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$879.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$747.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$615.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$879.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$659.93
|
| Rate for Payer: SOMOS Essential |
$659.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$879.91
|
|
|
PR RMVL LUNG OTHER THAN PNEUMONECT 1 SEGMENTECTOMY
|
Professional
|
Both
|
$6,373.89
|
|
|
Service Code
|
HCPCS 32484
|
| Min. Negotiated Rate |
$1,177.23 |
| Max. Negotiated Rate |
$3,783.96 |
| Rate for Payer: Cash Price |
$1,695.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,681.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,513.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,513.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,597.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,681.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,597.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,681.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,681.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,261.32
|
| Rate for Payer: Healthfirst Commercial |
$1,681.76
|
| Rate for Payer: Healthfirst Essential Plan |
$3,783.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,597.67
|
| Rate for Payer: Healthfirst QHP |
$1,681.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,177.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,681.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,429.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,177.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,681.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,261.32
|
| Rate for Payer: SOMOS Essential |
$1,261.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,681.76
|
|
|
PR RMVL LUNG OTHER THAN PNEUMONECT 2 LOBES BILOBEC
|
Professional
|
Both
|
$7,025.13
|
|
|
Service Code
|
HCPCS 32482
|
| Min. Negotiated Rate |
$1,300.49 |
| Max. Negotiated Rate |
$4,180.16 |
| Rate for Payer: Cash Price |
$1,871.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,857.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,672.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,672.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,764.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,857.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,764.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,857.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,857.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,393.39
|
| Rate for Payer: Healthfirst Commercial |
$1,857.85
|
| Rate for Payer: Healthfirst Essential Plan |
$4,180.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,764.96
|
| Rate for Payer: Healthfirst QHP |
$1,857.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,300.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,857.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,579.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,300.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,857.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,393.39
|
| Rate for Payer: SOMOS Essential |
$1,393.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,857.85
|
|
|
PR RMVL LUNG OTHER THAN PNEUMONECTOMY 1 LOBE LOBECT
|
Professional
|
Both
|
$6,573.35
|
|
|
Service Code
|
HCPCS 32480
|
| Min. Negotiated Rate |
$1,214.72 |
| Max. Negotiated Rate |
$3,904.47 |
| Rate for Payer: Cash Price |
$1,750.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,735.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,561.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,561.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,648.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,735.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,648.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,735.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,735.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,301.49
|
| Rate for Payer: Healthfirst Commercial |
$1,735.32
|
| Rate for Payer: Healthfirst Essential Plan |
$3,904.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,648.55
|
| Rate for Payer: Healthfirst QHP |
$1,735.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,214.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,735.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,475.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,214.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,735.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,301.49
|
| Rate for Payer: SOMOS Essential |
$1,301.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,735.32
|
|
|
PR RMVL LUNG OTHER/THAN PNUMEC COMPLETION PNUMEC
|
Professional
|
Both
|
$10,641.40
|
|
|
Service Code
|
HCPCS 32488
|
| Min. Negotiated Rate |
$1,959.22 |
| Max. Negotiated Rate |
$6,297.48 |
| Rate for Payer: Cash Price |
$2,828.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,798.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,518.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,518.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,658.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,798.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,658.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,798.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,798.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,099.16
|
| Rate for Payer: Healthfirst Commercial |
$2,798.88
|
| Rate for Payer: Healthfirst Essential Plan |
$6,297.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,658.94
|
| Rate for Payer: Healthfirst QHP |
$2,798.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,959.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,798.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,379.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,959.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,798.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,099.16
|
| Rate for Payer: SOMOS Essential |
$2,099.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,798.88
|
|
|
PR RMVL LUNG OTH/THN PNUMEC RESXN-PLCTJ EMPHY LUNG
|
Professional
|
Both
|
$6,554.45
|
|
|
Service Code
|
HCPCS 32491
|
| Min. Negotiated Rate |
$1,212.54 |
| Max. Negotiated Rate |
$3,897.45 |
| Rate for Payer: Cash Price |
$1,747.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,732.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,558.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,558.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,645.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,732.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,645.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,732.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,732.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,299.15
|
| Rate for Payer: Healthfirst Commercial |
$1,732.20
|
| Rate for Payer: Healthfirst Essential Plan |
$3,897.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,645.59
|
| Rate for Payer: Healthfirst QHP |
$1,732.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,212.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,732.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,472.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,212.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,732.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,299.15
|
| Rate for Payer: SOMOS Essential |
$1,299.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,732.20
|
|
|
PR RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE LOBECTOMY
|
Professional
|
Both
|
$10,422.37
|
|
|
Service Code
|
HCPCS 32486
|
| Min. Negotiated Rate |
$1,915.21 |
| Max. Negotiated Rate |
$6,156.05 |
| Rate for Payer: Cash Price |
$2,767.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,736.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,462.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,462.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,599.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,736.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,599.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,736.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,736.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,052.01
|
| Rate for Payer: Healthfirst Commercial |
$2,736.02
|
| Rate for Payer: Healthfirst Essential Plan |
$6,156.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,599.22
|
| Rate for Payer: Healthfirst QHP |
$2,736.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,915.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,736.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,325.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,915.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,736.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,052.01
|
| Rate for Payer: SOMOS Essential |
$2,052.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,736.02
|
|
|
PR RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF
|
Professional
|
Both
|
$666.93
|
|
|
Service Code
|
HCPCS 32552
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$401.62 |
| Rate for Payer: Cash Price |
$180.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$178.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$160.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$169.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$178.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$169.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.88
|
| Rate for Payer: Healthfirst Commercial |
$178.50
|
| Rate for Payer: Healthfirst Essential Plan |
$401.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$169.57
|
| Rate for Payer: Healthfirst QHP |
$178.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$124.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$178.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$151.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$124.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$178.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$133.88
|
| Rate for Payer: SOMOS Essential |
$133.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$178.50
|
|
|
PR RMVL NFROS TUBE REQ FLUORO GUIDANCE
|
Professional
|
Both
|
$218.19
|
|
|
Service Code
|
HCPCS 50389
|
| Min. Negotiated Rate |
$41.66 |
| Max. Negotiated Rate |
$133.92 |
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.64
|
| Rate for Payer: Healthfirst Commercial |
$59.52
|
| Rate for Payer: Healthfirst Essential Plan |
$133.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.54
|
| Rate for Payer: Healthfirst QHP |
$59.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.64
|
| Rate for Payer: SOMOS Essential |
$44.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.52
|
|
|
PR RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR
|
Professional
|
Both
|
$878.47
|
|
|
Service Code
|
HCPCS 49623
|
| Min. Negotiated Rate |
$168.38 |
| Max. Negotiated Rate |
$541.24 |
| Rate for Payer: Cash Price |
$232.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$240.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$216.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$216.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$228.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$240.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$228.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$240.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.41
|
| Rate for Payer: Healthfirst Commercial |
$240.55
|
| Rate for Payer: Healthfirst Essential Plan |
$541.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$228.52
|
| Rate for Payer: Healthfirst QHP |
$240.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$168.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$240.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$204.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$168.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$240.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$180.41
|
| Rate for Payer: SOMOS Essential |
$180.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$240.55
|
|
|
PR RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT
|
Professional
|
Both
|
$2,234.54
|
|
|
Service Code
|
HCPCS 54415
|
| Min. Negotiated Rate |
$426.99 |
| Max. Negotiated Rate |
$1,372.48 |
| Rate for Payer: Cash Price |
$615.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$609.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$548.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$548.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$579.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$609.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$579.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$609.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$609.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$457.49
|
| Rate for Payer: Healthfirst Commercial |
$609.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,372.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$579.49
|
| Rate for Payer: Healthfirst QHP |
$609.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$426.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$609.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$518.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$426.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$609.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$457.49
|
| Rate for Payer: SOMOS Essential |
$457.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$609.99
|
|
|
PR RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Professional
|
Both
|
$1,531.74
|
|
|
Service Code
|
HCPCS 33272
|
| Min. Negotiated Rate |
$284.35 |
| Max. Negotiated Rate |
$913.97 |
| Rate for Payer: Cash Price |
$408.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$406.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$365.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$365.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$385.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$406.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$385.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$406.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$304.66
|
| Rate for Payer: Healthfirst Commercial |
$406.21
|
| Rate for Payer: Healthfirst Essential Plan |
$913.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$385.90
|
| Rate for Payer: Healthfirst QHP |
$406.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$284.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$406.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$345.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$284.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$406.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$304.66
|
| Rate for Payer: SOMOS Essential |
$304.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$406.21
|
|
|
PR RMVL PERITONEAL-VENOUS SHUNT
|
Professional
|
Both
|
$2,078.76
|
|
|
Service Code
|
HCPCS 49429
|
| Min. Negotiated Rate |
$384.17 |
| Max. Negotiated Rate |
$1,234.82 |
| Rate for Payer: Cash Price |
$551.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$548.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$493.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$493.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$521.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$548.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$521.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$548.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$548.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$411.61
|
| Rate for Payer: Healthfirst Commercial |
$548.81
|
| Rate for Payer: Healthfirst Essential Plan |
$1,234.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$521.37
|
| Rate for Payer: Healthfirst QHP |
$548.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$384.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$548.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$466.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$384.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$548.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$411.61
|
| Rate for Payer: SOMOS Essential |
$411.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$548.81
|
|
|
PR RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH
|
Professional
|
Both
|
$1,228.19
|
|
|
Service Code
|
HCPCS 62355
|
| Min. Negotiated Rate |
$235.90 |
| Max. Negotiated Rate |
$758.25 |
| Rate for Payer: Cash Price |
$333.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$337.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$303.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$303.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$320.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$337.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$320.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.75
|
| Rate for Payer: Healthfirst Commercial |
$337.00
|
| Rate for Payer: Healthfirst Essential Plan |
$758.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$320.15
|
| Rate for Payer: Healthfirst QHP |
$337.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$235.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$337.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$286.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$235.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$337.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.75
|
| Rate for Payer: SOMOS Essential |
$252.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$337.00
|
|
|
PR RMVL PRM EPICAR PM&ELTRDS THORCOM 1 LEAD SYS
|
Professional
|
Both
|
$3,462.13
|
|
|
Service Code
|
HCPCS 33236
|
| Min. Negotiated Rate |
$643.03 |
| Max. Negotiated Rate |
$2,066.89 |
| Rate for Payer: Cash Price |
$923.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$918.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$826.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$826.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$872.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$918.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$872.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$918.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$918.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$688.97
|
| Rate for Payer: Healthfirst Commercial |
$918.62
|
| Rate for Payer: Healthfirst Essential Plan |
$2,066.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$872.69
|
| Rate for Payer: Healthfirst QHP |
$918.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$643.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$918.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$780.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$643.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$918.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$688.97
|
| Rate for Payer: SOMOS Essential |
$688.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$918.62
|
|
|
PR RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SY
|
Professional
|
Both
|
$3,711.37
|
|
|
Service Code
|
HCPCS 33237
|
| Min. Negotiated Rate |
$688.77 |
| Max. Negotiated Rate |
$2,213.91 |
| Rate for Payer: Cash Price |
$991.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$983.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$885.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$885.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$934.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$983.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$934.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$983.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$983.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$737.97
|
| Rate for Payer: Healthfirst Commercial |
$983.96
|
| Rate for Payer: Healthfirst Essential Plan |
$2,213.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$934.76
|
| Rate for Payer: Healthfirst QHP |
$983.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$688.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$983.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$836.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$688.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$983.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$737.97
|
| Rate for Payer: SOMOS Essential |
$737.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$983.96
|
|
|
PR RMVL PRM TRANSVENOUS ELECTRODE THORACOTOMY
|
Professional
|
Both
|
$4,200.81
|
|
|
Service Code
|
HCPCS 33238
|
| Min. Negotiated Rate |
$775.60 |
| Max. Negotiated Rate |
$2,493.00 |
| Rate for Payer: Cash Price |
$1,122.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,108.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$997.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$997.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,052.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,108.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,052.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,108.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,108.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$831.00
|
| Rate for Payer: Healthfirst Commercial |
$1,108.00
|
| Rate for Payer: Healthfirst Essential Plan |
$2,493.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,052.60
|
| Rate for Payer: Healthfirst QHP |
$1,108.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$775.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,108.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$941.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$775.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,108.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$831.00
|
| Rate for Payer: SOMOS Essential |
$831.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,108.00
|
|
|
PR RMVL PROSTC MATRL/MESH ABDL WALL FOR INFECTION
|
Professional
|
Both
|
$1,224.83
|
|
|
Service Code
|
HCPCS 11008
|
| Min. Negotiated Rate |
$224.88 |
| Max. Negotiated Rate |
$722.81 |
| Rate for Payer: Cash Price |
$324.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$321.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$305.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$321.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$305.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$240.94
|
| Rate for Payer: Healthfirst Commercial |
$321.25
|
| Rate for Payer: Healthfirst Essential Plan |
$722.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$305.19
|
| Rate for Payer: Healthfirst QHP |
$321.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$224.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$321.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$273.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$224.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$321.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$240.94
|
| Rate for Payer: SOMOS Essential |
$240.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$321.25
|
|
|
PR RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER
|
Professional
|
Both
|
$5,297.88
|
|
|
Service Code
|
HCPCS 27488
|
| Min. Negotiated Rate |
$995.42 |
| Max. Negotiated Rate |
$3,199.57 |
| Rate for Payer: Cash Price |
$1,429.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,422.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,279.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,279.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,350.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,422.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,350.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,422.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,422.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,066.52
|
| Rate for Payer: Healthfirst Commercial |
$1,422.03
|
| Rate for Payer: Healthfirst Essential Plan |
$3,199.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,350.93
|
| Rate for Payer: Healthfirst QHP |
$1,422.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$995.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,422.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,208.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$995.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,422.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,066.52
|
| Rate for Payer: SOMOS Essential |
$1,066.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,422.03
|
|
|
PR RMVL/REVJ SLING MALE URINARY INCONTINENCE
|
Professional
|
Both
|
$3,294.62
|
|
|
Service Code
|
HCPCS 53442
|
| Min. Negotiated Rate |
$629.39 |
| Max. Negotiated Rate |
$2,023.04 |
| Rate for Payer: Cash Price |
$903.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$899.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$809.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$809.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$854.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$899.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$854.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$899.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$899.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$674.35
|
| Rate for Payer: Healthfirst Commercial |
$899.13
|
| Rate for Payer: Healthfirst Essential Plan |
$2,023.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$854.17
|
| Rate for Payer: Healthfirst QHP |
$899.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$629.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$899.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$764.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$629.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$899.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$674.35
|
| Rate for Payer: SOMOS Essential |
$674.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$899.13
|
|
|
PR RMVL/REVJ SLING STRESS INCONTINENCE
|
Professional
|
Both
|
$3,205.27
|
|
|
Service Code
|
HCPCS 57287
|
| Min. Negotiated Rate |
$599.80 |
| Max. Negotiated Rate |
$1,927.93 |
| Rate for Payer: Cash Price |
$870.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$856.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$771.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$771.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$814.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$856.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$814.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$856.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$856.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$642.64
|
| Rate for Payer: Healthfirst Commercial |
$856.86
|
| Rate for Payer: Healthfirst Essential Plan |
$1,927.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$814.02
|
| Rate for Payer: Healthfirst QHP |
$856.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$599.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$856.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$728.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$599.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$856.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$642.64
|
| Rate for Payer: SOMOS Essential |
$642.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$856.86
|
|
