|
PR RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS
|
Professional
|
Both
|
$3,614.21
|
|
|
Service Code
|
HCPCS 54410
|
| Min. Negotiated Rate |
$689.12 |
| Max. Negotiated Rate |
$2,215.03 |
| Rate for Payer: Cash Price |
$990.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$984.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$886.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$886.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$935.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$984.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$935.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$984.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$984.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$738.35
|
| Rate for Payer: Healthfirst Commercial |
$984.46
|
| Rate for Payer: Healthfirst Essential Plan |
$2,215.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$935.24
|
| Rate for Payer: Healthfirst QHP |
$984.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$689.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$984.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$836.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$689.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$984.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$738.35
|
| Rate for Payer: SOMOS Essential |
$738.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$984.46
|
|
|
PR RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ
|
Professional
|
Both
|
$1,032.29
|
|
|
Service Code
|
HCPCS 50382
|
| Min. Negotiated Rate |
$193.49 |
| Max. Negotiated Rate |
$621.92 |
| Rate for Payer: Cash Price |
$277.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$276.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$248.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$248.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$262.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$276.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$262.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$276.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$276.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$207.31
|
| Rate for Payer: Healthfirst Commercial |
$276.41
|
| Rate for Payer: Healthfirst Essential Plan |
$621.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$262.59
|
| Rate for Payer: Healthfirst QHP |
$276.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$193.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$276.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$234.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$193.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$276.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$207.31
|
| Rate for Payer: SOMOS Essential |
$207.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$276.41
|
|
|
PR RMVL & RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD
|
Professional
|
Both
|
$5,323.57
|
|
|
Service Code
|
HCPCS 53448
|
| Min. Negotiated Rate |
$1,010.87 |
| Max. Negotiated Rate |
$3,249.22 |
| Rate for Payer: Cash Price |
$1,452.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,444.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,299.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,299.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,371.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,444.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,371.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,444.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,444.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,083.08
|
| Rate for Payer: Healthfirst Commercial |
$1,444.10
|
| Rate for Payer: Healthfirst Essential Plan |
$3,249.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,371.89
|
| Rate for Payer: Healthfirst QHP |
$1,444.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,010.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,444.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,227.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,010.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,444.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,083.08
|
| Rate for Payer: SOMOS Essential |
$1,083.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,444.10
|
|
|
PR RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL
|
Professional
|
Both
|
$4,317.22
|
|
|
Service Code
|
HCPCS 54411
|
| Min. Negotiated Rate |
$819.50 |
| Max. Negotiated Rate |
$2,634.12 |
| Rate for Payer: Cash Price |
$1,177.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,170.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,053.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,053.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,112.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,170.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,112.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,170.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,170.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$878.04
|
| Rate for Payer: Healthfirst Commercial |
$1,170.72
|
| Rate for Payer: Healthfirst Essential Plan |
$2,634.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,112.18
|
| Rate for Payer: Healthfirst QHP |
$1,170.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$819.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,170.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$995.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$819.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,170.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$878.04
|
| Rate for Payer: SOMOS Essential |
$878.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,170.72
|
|
|
PR RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC
|
Professional
|
Both
|
$3,375.09
|
|
|
Service Code
|
HCPCS 53447
|
| Min. Negotiated Rate |
$642.40 |
| Max. Negotiated Rate |
$2,064.85 |
| Rate for Payer: Cash Price |
$923.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$917.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$825.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$825.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$871.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$917.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$871.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$917.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$917.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$688.28
|
| Rate for Payer: Healthfirst Commercial |
$917.71
|
| Rate for Payer: Healthfirst Essential Plan |
$2,064.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$871.82
|
| Rate for Payer: Healthfirst QHP |
$917.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$642.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$917.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$780.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$642.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$917.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$688.28
|
| Rate for Payer: SOMOS Essential |
$688.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$917.71
|
|
|
PR RMVL & RPLCMT NON-NFLTBL/NFLTBL PENILE PROSTHESI
|
Professional
|
Both
|
$3,007.97
|
|
|
Service Code
|
HCPCS 54416
|
| Min. Negotiated Rate |
$574.45 |
| Max. Negotiated Rate |
$1,846.44 |
| Rate for Payer: Cash Price |
$827.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$820.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$738.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$738.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$779.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$820.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$779.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$820.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$820.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$615.48
|
| Rate for Payer: Healthfirst Commercial |
$820.64
|
| Rate for Payer: Healthfirst Essential Plan |
$1,846.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$779.61
|
| Rate for Payer: Healthfirst QHP |
$820.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$574.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$820.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$697.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$574.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$820.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$615.48
|
| Rate for Payer: SOMOS Essential |
$615.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$820.64
|
|
|
PR RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD
|
Professional
|
Both
|
$3,764.99
|
|
|
Service Code
|
HCPCS 54417
|
| Min. Negotiated Rate |
$716.61 |
| Max. Negotiated Rate |
$2,303.39 |
| Rate for Payer: Cash Price |
$1,029.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,023.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$921.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$921.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$972.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,023.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$972.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,023.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,023.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$767.80
|
| Rate for Payer: Healthfirst Commercial |
$1,023.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,303.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$972.54
|
| Rate for Payer: Healthfirst QHP |
$1,023.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$716.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,023.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$870.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$716.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,023.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$767.80
|
| Rate for Payer: SOMOS Essential |
$767.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,023.73
|
|
|
PR RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH
|
Professional
|
Both
|
$340.31
|
|
|
Service Code
|
HCPCS 50387
|
| Min. Negotiated Rate |
$63.85 |
| Max. Negotiated Rate |
$205.22 |
| Rate for Payer: Cash Price |
$91.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.41
|
| Rate for Payer: Healthfirst Commercial |
$91.21
|
| Rate for Payer: Healthfirst Essential Plan |
$205.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.65
|
| Rate for Payer: Healthfirst QHP |
$91.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.41
|
| Rate for Payer: SOMOS Essential |
$68.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.21
|
|
|
PR RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE
|
Professional
|
Both
|
$3,644.97
|
|
|
Service Code
|
HCPCS 69711
|
| Min. Negotiated Rate |
$675.41 |
| Max. Negotiated Rate |
$2,170.96 |
| Rate for Payer: Cash Price |
$983.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$964.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$868.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$868.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$916.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$964.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$916.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$964.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$964.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$723.65
|
| Rate for Payer: Healthfirst Commercial |
$964.87
|
| Rate for Payer: Healthfirst Essential Plan |
$2,170.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$916.63
|
| Rate for Payer: Healthfirst QHP |
$964.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$675.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$964.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$820.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$675.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$964.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$723.65
|
| Rate for Payer: SOMOS Essential |
$723.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$964.87
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Professional
|
Both
|
$2,837.66
|
|
|
Service Code
|
HCPCS 19330
|
| Min. Negotiated Rate |
$533.77 |
| Max. Negotiated Rate |
$1,715.69 |
| Rate for Payer: Cash Price |
$764.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$762.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$686.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$686.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$762.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$762.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$762.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$571.90
|
| Rate for Payer: Healthfirst Commercial |
$762.53
|
| Rate for Payer: Healthfirst Essential Plan |
$1,715.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$724.40
|
| Rate for Payer: Healthfirst QHP |
$762.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$533.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$762.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$648.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$533.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$762.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$571.90
|
| Rate for Payer: SOMOS Essential |
$571.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$762.53
|
|
|
PR RMVL SEC MEMBRANOUS CTRC CORNEO-SCLL SCTJ
|
Professional
|
Both
|
$2,912.60
|
|
|
Service Code
|
HCPCS 66830
|
| Min. Negotiated Rate |
$554.48 |
| Max. Negotiated Rate |
$1,782.27 |
| Rate for Payer: Cash Price |
$803.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$792.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$712.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$712.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$752.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$792.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$752.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$792.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$792.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$594.09
|
| Rate for Payer: Healthfirst Commercial |
$792.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,782.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$752.51
|
| Rate for Payer: Healthfirst QHP |
$792.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$554.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$792.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$673.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$554.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$792.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$594.09
|
| Rate for Payer: SOMOS Essential |
$594.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$792.12
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10
|
Professional
|
Both
|
$70.28
|
|
|
Service Code
|
HCPCS 11201
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$40.63 |
| Rate for Payer: Cash Price |
$18.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.54
|
| Rate for Payer: Healthfirst Commercial |
$18.06
|
| Rate for Payer: Healthfirst Essential Plan |
$40.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.16
|
| Rate for Payer: Healthfirst QHP |
$18.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.54
|
| Rate for Payer: SOMOS Essential |
$13.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.06
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Professional
|
Both
|
$325.57
|
|
|
Service Code
|
HCPCS 11200
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$199.57 |
| Rate for Payer: Cash Price |
$89.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$88.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.53
|
| Rate for Payer: Healthfirst Commercial |
$88.70
|
| Rate for Payer: Healthfirst Essential Plan |
$199.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.27
|
| Rate for Payer: Healthfirst QHP |
$88.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.53
|
| Rate for Payer: SOMOS Essential |
$66.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.70
|
|
|
PR RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR
|
Professional
|
Both
|
$3,970.26
|
|
|
Service Code
|
HCPCS 63662
|
| Min. Negotiated Rate |
$738.50 |
| Max. Negotiated Rate |
$2,373.75 |
| Rate for Payer: Cash Price |
$1,064.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,055.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$949.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$949.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,002.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,055.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,002.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,055.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,055.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$791.25
|
| Rate for Payer: Healthfirst Commercial |
$1,055.00
|
| Rate for Payer: Healthfirst Essential Plan |
$2,373.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,002.25
|
| Rate for Payer: Healthfirst QHP |
$1,055.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$738.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,055.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$896.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$738.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,055.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$791.25
|
| Rate for Payer: SOMOS Essential |
$791.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,055.00
|
|
|
PR RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR
|
Professional
|
Both
|
$1,440.74
|
|
|
Service Code
|
HCPCS 63661
|
| Min. Negotiated Rate |
$272.71 |
| Max. Negotiated Rate |
$876.58 |
| Rate for Payer: Cash Price |
$392.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$389.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$350.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$350.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$370.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$389.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$370.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$389.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$389.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$292.19
|
| Rate for Payer: Healthfirst Commercial |
$389.59
|
| Rate for Payer: Healthfirst Essential Plan |
$876.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$370.11
|
| Rate for Payer: Healthfirst QHP |
$389.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$272.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$389.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$331.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$272.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$389.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$292.19
|
| Rate for Payer: SOMOS Essential |
$292.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$389.59
|
|
|
PR RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS
|
Professional
|
Both
|
$1,332.63
|
|
|
Service Code
|
HCPCS 62365
|
| Min. Negotiated Rate |
$251.29 |
| Max. Negotiated Rate |
$807.73 |
| Rate for Payer: Cash Price |
$362.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$358.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$323.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$341.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$358.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$341.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$358.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$358.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$269.24
|
| Rate for Payer: Healthfirst Commercial |
$358.99
|
| Rate for Payer: Healthfirst Essential Plan |
$807.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$341.04
|
| Rate for Payer: Healthfirst QHP |
$358.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$251.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$358.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$305.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$251.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$358.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$269.24
|
| Rate for Payer: SOMOS Essential |
$269.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$358.99
|
|
|
PR RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD
|
Professional
|
Both
|
$4,447.00
|
|
|
Service Code
|
HCPCS 26392
|
| Min. Negotiated Rate |
$823.47 |
| Max. Negotiated Rate |
$2,646.86 |
| Rate for Payer: Cash Price |
$1,197.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,176.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,058.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,058.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,117.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,176.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,117.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,176.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,176.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$882.28
|
| Rate for Payer: Healthfirst Commercial |
$1,176.38
|
| Rate for Payer: Healthfirst Essential Plan |
$2,646.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,117.56
|
| Rate for Payer: Healthfirst QHP |
$1,176.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$823.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,176.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$999.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$823.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,176.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$882.28
|
| Rate for Payer: SOMOS Essential |
$882.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,176.38
|
|
|
PR RMVL SYNTH ROD & INSJ XTNSR TDN GRF H/F EA ROD
|
Professional
|
Both
|
$4,095.88
|
|
|
Service Code
|
HCPCS 26416
|
| Min. Negotiated Rate |
$759.04 |
| Max. Negotiated Rate |
$2,439.79 |
| Rate for Payer: Cash Price |
$1,102.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,084.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$975.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$975.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,030.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,084.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,030.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,084.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,084.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$813.26
|
| Rate for Payer: Healthfirst Commercial |
$1,084.35
|
| Rate for Payer: Healthfirst Essential Plan |
$2,439.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,030.13
|
| Rate for Payer: Healthfirst QHP |
$1,084.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$759.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,084.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$921.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$759.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,084.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$813.26
|
| Rate for Payer: SOMOS Essential |
$813.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,084.35
|
|
|
PR RMVL THIERSCH WIRE/SUTURE ANAL CANAL
|
Professional
|
Both
|
$1,035.58
|
|
|
Service Code
|
HCPCS 46754
|
| Min. Negotiated Rate |
$197.76 |
| Max. Negotiated Rate |
$635.67 |
| Rate for Payer: Cash Price |
$284.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$254.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$254.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$268.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$268.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$282.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.89
|
| Rate for Payer: Healthfirst Commercial |
$282.52
|
| Rate for Payer: Healthfirst Essential Plan |
$635.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$268.39
|
| Rate for Payer: Healthfirst QHP |
$282.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$197.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$240.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$197.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$211.89
|
| Rate for Payer: SOMOS Essential |
$211.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.52
|
|
|
PR RMVL TRANSPLANTED PANCREATIC ALLOGRAFT
|
Professional
|
Both
|
$5,812.07
|
|
|
Service Code
|
HCPCS 48556
|
| Min. Negotiated Rate |
$1,085.44 |
| Max. Negotiated Rate |
$3,488.92 |
| Rate for Payer: Cash Price |
$1,557.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,550.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,395.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,395.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,473.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,550.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,473.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,550.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,550.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,162.97
|
| Rate for Payer: Healthfirst Commercial |
$1,550.63
|
| Rate for Payer: Healthfirst Essential Plan |
$3,488.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,473.10
|
| Rate for Payer: Healthfirst QHP |
$1,550.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,085.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,550.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,318.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,085.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,550.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,162.97
|
| Rate for Payer: SOMOS Essential |
$1,162.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,550.63
|
|
|
PR RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR
|
Professional
|
Both
|
$2,137.70
|
|
|
Service Code
|
HCPCS 33234
|
| Min. Negotiated Rate |
$394.07 |
| Max. Negotiated Rate |
$1,266.66 |
| Rate for Payer: Cash Price |
$567.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$562.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$506.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$506.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$534.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$562.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$534.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$562.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$562.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$422.22
|
| Rate for Payer: Healthfirst Commercial |
$562.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,266.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$534.81
|
| Rate for Payer: Healthfirst QHP |
$562.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$394.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$562.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$478.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$394.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$562.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$422.22
|
| Rate for Payer: SOMOS Essential |
$422.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$562.96
|
|
|
PR RMVL TRANSVNS PM ELTRD DUAL LEAD SYS
|
Professional
|
Both
|
$2,817.57
|
|
|
Service Code
|
HCPCS 33235
|
| Min. Negotiated Rate |
$517.70 |
| Max. Negotiated Rate |
$1,664.03 |
| Rate for Payer: Cash Price |
$746.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$739.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$665.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$665.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$702.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$739.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$702.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$739.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$739.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$554.68
|
| Rate for Payer: Healthfirst Commercial |
$739.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,664.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$702.59
|
| Rate for Payer: Healthfirst QHP |
$739.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$517.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$739.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$628.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$517.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$739.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$554.68
|
| Rate for Payer: SOMOS Essential |
$554.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$739.57
|
|
|
PR RMVL TRNSPLED RENAL ALLOGRAFT
|
Professional
|
Both
|
$5,440.09
|
|
|
Service Code
|
HCPCS 50370
|
| Min. Negotiated Rate |
$1,019.14 |
| Max. Negotiated Rate |
$3,275.80 |
| Rate for Payer: Cash Price |
$1,462.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,455.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,310.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,310.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,383.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,455.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,383.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,455.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,455.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,091.93
|
| Rate for Payer: Healthfirst Commercial |
$1,455.91
|
| Rate for Payer: Healthfirst Essential Plan |
$3,275.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,383.11
|
| Rate for Payer: Healthfirst QHP |
$1,455.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,019.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,455.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,237.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,019.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,455.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,091.93
|
| Rate for Payer: SOMOS Essential |
$1,091.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,455.91
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
Both
|
$820.65
|
|
|
Service Code
|
HCPCS 36590
|
| Min. Negotiated Rate |
$152.57 |
| Max. Negotiated Rate |
$490.41 |
| Rate for Payer: Cash Price |
$219.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$217.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$196.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$207.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$217.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$207.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.47
|
| Rate for Payer: Healthfirst Commercial |
$217.96
|
| Rate for Payer: Healthfirst Essential Plan |
$490.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$207.06
|
| Rate for Payer: Healthfirst QHP |
$217.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$152.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$217.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$185.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$152.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$217.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$163.47
|
| Rate for Payer: SOMOS Essential |
$163.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$217.96
|
|
|
PR RMVL TUN CVC W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$582.72
|
|
|
Service Code
|
HCPCS 36589
|
| Min. Negotiated Rate |
$108.82 |
| Max. Negotiated Rate |
$349.79 |
| Rate for Payer: Cash Price |
$156.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$155.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.59
|
| Rate for Payer: Healthfirst Commercial |
$155.46
|
| Rate for Payer: Healthfirst Essential Plan |
$349.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.69
|
| Rate for Payer: Healthfirst QHP |
$155.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.59
|
| Rate for Payer: SOMOS Essential |
$116.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.46
|
|
