|
PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15
|
Professional
|
Both
|
$69.93
|
|
|
Service Code
|
HCPCS 92627
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$19.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.23
|
| Rate for Payer: Healthfirst Commercial |
$18.97
|
| Rate for Payer: Healthfirst Essential Plan |
$42.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.02
|
| Rate for Payer: Healthfirst QHP |
$18.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.23
|
| Rate for Payer: SOMOS Essential |
$14.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.97
|
|
|
PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN
|
Professional
|
Both
|
$317.84
|
|
|
Service Code
|
HCPCS 92620
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$194.31 |
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.77
|
| Rate for Payer: Healthfirst Commercial |
$86.36
|
| Rate for Payer: Healthfirst Essential Plan |
$194.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.04
|
| Rate for Payer: Healthfirst QHP |
$86.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.77
|
| Rate for Payer: SOMOS Essential |
$64.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.36
|
|
|
PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Professional
|
Both
|
$73.89
|
|
|
Service Code
|
HCPCS 92621
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$45.99 |
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.33
|
| Rate for Payer: Healthfirst Commercial |
$20.44
|
| Rate for Payer: Healthfirst Essential Plan |
$45.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.42
|
| Rate for Payer: Healthfirst QHP |
$20.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.33
|
| Rate for Payer: SOMOS Essential |
$15.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.44
|
|
|
PR EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC
|
Professional
|
Both
|
$289.52
|
|
|
Service Code
|
HCPCS 92597
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$181.82 |
| Rate for Payer: Amida Care Medicaid |
$24.24
|
| Rate for Payer: Cash Price |
$80.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.61
|
| Rate for Payer: Healthfirst Commercial |
$80.81
|
| Rate for Payer: Healthfirst Essential Plan |
$181.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.77
|
| Rate for Payer: Healthfirst QHP |
$80.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.61
|
| Rate for Payer: SOMOS Essential |
$60.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.81
|
|
|
PR EVAL ORAL&PHARYNGEAL SWLNG FUNCJ
|
Professional
|
Both
|
$280.14
|
|
|
Service Code
|
HCPCS 92610
|
| Min. Negotiated Rate |
$54.54 |
| Max. Negotiated Rate |
$175.32 |
| Rate for Payer: Amida Care Medicaid |
$54.75
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.44
|
| Rate for Payer: Healthfirst Commercial |
$77.92
|
| Rate for Payer: Healthfirst Essential Plan |
$175.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.02
|
| Rate for Payer: Healthfirst QHP |
$77.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.44
|
| Rate for Payer: SOMOS Essential |
$58.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.92
|
|
|
PR EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION
|
Professional
|
Both
|
$917.98
|
|
|
Service Code
|
HCPCS 92523
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$570.94 |
| Rate for Payer: Amida Care Medicaid |
$101.20
|
| Rate for Payer: Cash Price |
$254.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$253.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$228.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$228.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$241.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$253.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$241.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$253.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$253.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$190.31
|
| Rate for Payer: Healthfirst Commercial |
$253.75
|
| Rate for Payer: Healthfirst Essential Plan |
$570.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.06
|
| Rate for Payer: Healthfirst QHP |
$253.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$177.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$253.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$215.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$177.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$253.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$190.31
|
| Rate for Payer: SOMOS Essential |
$190.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.75
|
|
|
PR EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)
|
Professional
|
Both
|
$535.61
|
|
|
Service Code
|
HCPCS 92521
|
| Min. Negotiated Rate |
$60.03 |
| Max. Negotiated Rate |
$333.40 |
| Rate for Payer: Amida Care Medicaid |
$60.03
|
| Rate for Payer: Cash Price |
$148.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$148.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$148.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.14
|
| Rate for Payer: Healthfirst Commercial |
$148.18
|
| Rate for Payer: Healthfirst Essential Plan |
$333.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.77
|
| Rate for Payer: Healthfirst QHP |
$148.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$148.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$148.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.14
|
| Rate for Payer: SOMOS Essential |
$111.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.18
|
|
|
PR EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE
|
Professional
|
Both
|
$449.37
|
|
|
Service Code
|
HCPCS 92522
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$277.69 |
| Rate for Payer: Amida Care Medicaid |
$48.64
|
| Rate for Payer: Cash Price |
$124.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.56
|
| Rate for Payer: Healthfirst Commercial |
$123.42
|
| Rate for Payer: Healthfirst Essential Plan |
$277.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.25
|
| Rate for Payer: Healthfirst QHP |
$123.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.56
|
| Rate for Payer: SOMOS Essential |
$92.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.42
|
|
|
PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST
|
Professional
|
Both
|
$2,643.55
|
|
|
Service Code
|
HCPCS 61650
|
| Min. Negotiated Rate |
$500.23 |
| Max. Negotiated Rate |
$1,607.89 |
| Rate for Payer: Cash Price |
$714.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$714.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$643.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$643.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$678.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$714.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$678.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$714.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$535.97
|
| Rate for Payer: Healthfirst Commercial |
$714.62
|
| Rate for Payer: Healthfirst Essential Plan |
$1,607.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$678.89
|
| Rate for Payer: Healthfirst QHP |
$714.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$500.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$714.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$607.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$500.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$714.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$535.97
|
| Rate for Payer: SOMOS Essential |
$535.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$714.62
|
|
|
PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART ADDL
|
Professional
|
Both
|
$1,146.50
|
|
|
Service Code
|
HCPCS 61651
|
| Min. Negotiated Rate |
$213.71 |
| Max. Negotiated Rate |
$686.92 |
| Rate for Payer: Cash Price |
$305.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$305.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$274.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$274.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$290.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$305.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$290.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$305.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$305.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$228.97
|
| Rate for Payer: Healthfirst Commercial |
$305.30
|
| Rate for Payer: Healthfirst Essential Plan |
$686.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$290.04
|
| Rate for Payer: Healthfirst QHP |
$305.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$213.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$305.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$259.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$213.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$305.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$228.97
|
| Rate for Payer: SOMOS Essential |
$228.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.30
|
|
|
PR EVASC PLACEMENT ILIAC ARTERY OCCLUSION DEVICE
|
Professional
|
Both
|
$897.72
|
|
|
Service Code
|
HCPCS 34808
|
| Min. Negotiated Rate |
$164.25 |
| Max. Negotiated Rate |
$527.94 |
| Rate for Payer: Cash Price |
$237.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$234.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$211.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$211.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$222.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$234.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$222.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$234.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$234.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.98
|
| Rate for Payer: Healthfirst Commercial |
$234.64
|
| Rate for Payer: Healthfirst Essential Plan |
$527.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$222.91
|
| Rate for Payer: Healthfirst QHP |
$234.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$164.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$234.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$199.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$164.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$234.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$175.98
|
| Rate for Payer: SOMOS Essential |
$175.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$234.64
|
|
|
PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT
|
Professional
|
Both
|
$5,464.69
|
|
|
Service Code
|
HCPCS 34701
|
| Min. Negotiated Rate |
$1,004.56 |
| Max. Negotiated Rate |
$3,228.95 |
| Rate for Payer: Cash Price |
$1,447.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,435.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,291.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,291.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,363.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,435.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,363.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,435.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,435.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,076.32
|
| Rate for Payer: Healthfirst Commercial |
$1,435.09
|
| Rate for Payer: Healthfirst Essential Plan |
$3,228.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,363.34
|
| Rate for Payer: Healthfirst QHP |
$1,435.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,004.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,435.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,219.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,004.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,435.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,076.32
|
| Rate for Payer: SOMOS Essential |
$1,076.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,435.09
|
|
|
PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT RPT
|
Professional
|
Both
|
$8,177.16
|
|
|
Service Code
|
HCPCS 34702
|
| Min. Negotiated Rate |
$1,460.87 |
| Max. Negotiated Rate |
$4,695.64 |
| Rate for Payer: Cash Price |
$2,165.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,086.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,878.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,878.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,982.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,086.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,982.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,086.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,086.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,565.21
|
| Rate for Payer: Healthfirst Commercial |
$2,086.95
|
| Rate for Payer: Healthfirst Essential Plan |
$4,695.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,982.60
|
| Rate for Payer: Healthfirst QHP |
$2,086.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,460.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,086.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,773.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,460.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,086.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,565.21
|
| Rate for Payer: SOMOS Essential |
$1,565.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,086.95
|
|
|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT
|
Professional
|
Both
|
$6,752.17
|
|
|
Service Code
|
HCPCS 34705
|
| Min. Negotiated Rate |
$1,236.80 |
| Max. Negotiated Rate |
$3,975.43 |
| Rate for Payer: Cash Price |
$1,788.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,766.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,590.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,590.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,678.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,766.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,678.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,766.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,766.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,325.14
|
| Rate for Payer: Healthfirst Commercial |
$1,766.86
|
| Rate for Payer: Healthfirst Essential Plan |
$3,975.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,678.52
|
| Rate for Payer: Healthfirst QHP |
$1,766.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,236.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,766.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,501.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,236.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,766.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,325.14
|
| Rate for Payer: SOMOS Essential |
$1,325.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,766.86
|
|
|
PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT
|
Professional
|
Both
|
$10,087.63
|
|
|
Service Code
|
HCPCS 34706
|
| Min. Negotiated Rate |
$1,848.55 |
| Max. Negotiated Rate |
$5,941.78 |
| Rate for Payer: Cash Price |
$2,668.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,640.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,376.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,376.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,508.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,640.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,508.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,640.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,640.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,980.59
|
| Rate for Payer: Healthfirst Commercial |
$2,640.79
|
| Rate for Payer: Healthfirst Essential Plan |
$5,941.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,508.75
|
| Rate for Payer: Healthfirst QHP |
$2,640.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,848.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,640.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,244.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,848.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,640.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,980.59
|
| Rate for Payer: SOMOS Essential |
$1,980.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,640.79
|
|
|
PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT
|
Professional
|
Both
|
$6,094.76
|
|
|
Service Code
|
HCPCS 34703
|
| Min. Negotiated Rate |
$1,113.91 |
| Max. Negotiated Rate |
$3,580.43 |
| Rate for Payer: Cash Price |
$1,608.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,591.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,432.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,432.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,511.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,591.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,511.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,591.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,591.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,193.47
|
| Rate for Payer: Healthfirst Commercial |
$1,591.30
|
| Rate for Payer: Healthfirst Essential Plan |
$3,580.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,511.73
|
| Rate for Payer: Healthfirst QHP |
$1,591.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,113.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,591.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,352.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,113.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,591.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,193.47
|
| Rate for Payer: SOMOS Essential |
$1,193.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,591.30
|
|
|
PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT RPT
|
Professional
|
Both
|
$10,139.33
|
|
|
Service Code
|
HCPCS 34704
|
| Min. Negotiated Rate |
$1,849.06 |
| Max. Negotiated Rate |
$5,943.42 |
| Rate for Payer: Cash Price |
$2,681.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,641.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,377.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,377.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,509.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,641.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,509.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,641.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,641.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,981.14
|
| Rate for Payer: Healthfirst Commercial |
$2,641.52
|
| Rate for Payer: Healthfirst Essential Plan |
$5,943.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,509.44
|
| Rate for Payer: Healthfirst QHP |
$2,641.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,849.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,641.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,245.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,849.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,641.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,981.14
|
| Rate for Payer: SOMOS Essential |
$1,981.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,641.52
|
|
|
PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT
|
Professional
|
Both
|
$5,154.77
|
|
|
Service Code
|
HCPCS 34707
|
| Min. Negotiated Rate |
$942.99 |
| Max. Negotiated Rate |
$3,031.04 |
| Rate for Payer: Cash Price |
$1,360.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,347.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,212.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,212.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,279.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,347.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,279.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,347.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,347.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,010.35
|
| Rate for Payer: Healthfirst Commercial |
$1,347.13
|
| Rate for Payer: Healthfirst Essential Plan |
$3,031.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,279.77
|
| Rate for Payer: Healthfirst QHP |
$1,347.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$942.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,347.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,145.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$942.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,347.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,010.35
|
| Rate for Payer: SOMOS Essential |
$1,010.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,347.13
|
|
|
PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT RPT
|
Professional
|
Both
|
$8,086.86
|
|
|
Service Code
|
HCPCS 34708
|
| Min. Negotiated Rate |
$1,480.29 |
| Max. Negotiated Rate |
$4,758.07 |
| Rate for Payer: Cash Price |
$2,139.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,114.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,903.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,903.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,008.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,114.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,008.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,114.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,114.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,586.03
|
| Rate for Payer: Healthfirst Commercial |
$2,114.70
|
| Rate for Payer: Healthfirst Essential Plan |
$4,758.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,008.96
|
| Rate for Payer: Healthfirst QHP |
$2,114.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,480.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,114.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,797.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,480.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,114.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,586.03
|
| Rate for Payer: SOMOS Essential |
$1,586.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,114.70
|
|
|
PR EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH
|
Professional
|
Both
|
$7,924.21
|
|
|
Service Code
|
HCPCS 33880
|
| Min. Negotiated Rate |
$1,447.94 |
| Max. Negotiated Rate |
$4,654.08 |
| Rate for Payer: Cash Price |
$2,094.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,068.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,861.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,861.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,965.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,068.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,965.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,068.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,068.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,551.36
|
| Rate for Payer: Healthfirst Commercial |
$2,068.48
|
| Rate for Payer: Healthfirst Essential Plan |
$4,654.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,965.06
|
| Rate for Payer: Healthfirst QHP |
$2,068.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,447.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,068.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,758.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,447.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,068.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,551.36
|
| Rate for Payer: SOMOS Essential |
$1,551.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,068.48
|
|
|
PR EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN
|
Professional
|
Both
|
$6,784.33
|
|
|
Service Code
|
HCPCS 33881
|
| Min. Negotiated Rate |
$1,243.98 |
| Max. Negotiated Rate |
$3,998.50 |
| Rate for Payer: Cash Price |
$1,799.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,777.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,599.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,599.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,688.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,777.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,688.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,777.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,777.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,332.83
|
| Rate for Payer: Healthfirst Commercial |
$1,777.11
|
| Rate for Payer: Healthfirst Essential Plan |
$3,998.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,688.25
|
| Rate for Payer: Healthfirst QHP |
$1,777.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,243.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,777.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,510.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,243.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,777.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,332.83
|
| Rate for Payer: SOMOS Essential |
$1,332.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,777.11
|
|
|
PR EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$5,460.67
|
|
|
Service Code
|
HCPCS 34718
|
| Min. Negotiated Rate |
$1,003.70 |
| Max. Negotiated Rate |
$3,226.18 |
| Rate for Payer: Cash Price |
$1,452.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,433.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,290.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,290.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,362.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,433.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,362.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,433.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,433.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,075.39
|
| Rate for Payer: Healthfirst Commercial |
$1,433.86
|
| Rate for Payer: Healthfirst Essential Plan |
$3,226.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,362.17
|
| Rate for Payer: Healthfirst QHP |
$1,433.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,003.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,433.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,218.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,003.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,433.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,075.39
|
| Rate for Payer: SOMOS Essential |
$1,075.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,433.86
|
|
|
PR EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI
|
Professional
|
Both
|
$1,957.69
|
|
|
Service Code
|
HCPCS 34717
|
| Min. Negotiated Rate |
$357.77 |
| Max. Negotiated Rate |
$1,149.97 |
| Rate for Payer: Cash Price |
$518.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$511.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$459.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$459.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$485.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$511.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$485.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$511.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$511.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$383.32
|
| Rate for Payer: Healthfirst Commercial |
$511.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,149.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$485.55
|
| Rate for Payer: Healthfirst QHP |
$511.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$357.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$511.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$434.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$357.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$511.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$383.32
|
| Rate for Payer: SOMOS Essential |
$383.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$511.10
|
|
|
PR EVASC ST RPR COARCJ THRC/AA ACRS MAJ SIDE BRNCH
|
Professional
|
Both
|
$4,313.89
|
|
|
Service Code
|
HCPCS 33894
|
| Min. Negotiated Rate |
$792.18 |
| Max. Negotiated Rate |
$2,546.30 |
| Rate for Payer: Cash Price |
$1,145.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,131.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,018.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,018.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,075.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,131.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,075.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,131.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,131.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$848.77
|
| Rate for Payer: Healthfirst Commercial |
$1,131.69
|
| Rate for Payer: Healthfirst Essential Plan |
$2,546.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,075.11
|
| Rate for Payer: Healthfirst QHP |
$1,131.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$792.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,131.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$961.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$792.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,131.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$848.77
|
| Rate for Payer: SOMOS Essential |
$848.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,131.69
|
|
|
PR EVASC ST RPR COARCJ THRC/AA XCRSG MAJ SIDE BRNCH
|
Professional
|
Both
|
$3,428.85
|
|
|
Service Code
|
HCPCS 33895
|
| Min. Negotiated Rate |
$629.97 |
| Max. Negotiated Rate |
$2,024.91 |
| Rate for Payer: Cash Price |
$911.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$899.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$809.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$809.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$854.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$899.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$854.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$899.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$899.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$674.97
|
| Rate for Payer: Healthfirst Commercial |
$899.96
|
| Rate for Payer: Healthfirst Essential Plan |
$2,024.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$854.96
|
| Rate for Payer: Healthfirst QHP |
$899.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$629.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$899.96
|
| 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) |
$629.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$899.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$674.97
|
| Rate for Payer: SOMOS Essential |
$674.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$899.96
|
|
