|
PR RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON
|
Professional
|
Both
|
$3,958.71
|
|
|
Service Code
|
HCPCS 26357
|
| Min. Negotiated Rate |
$745.02 |
| Max. Negotiated Rate |
$2,394.72 |
| Rate for Payer: Cash Price |
$1,070.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,064.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$957.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$957.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,011.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,064.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,011.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,064.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,064.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$798.24
|
| Rate for Payer: Healthfirst Commercial |
$1,064.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,394.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,011.10
|
| Rate for Payer: Healthfirst QHP |
$1,064.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$745.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,064.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$904.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$745.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,064.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$798.24
|
| Rate for Payer: SOMOS Essential |
$798.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,064.32
|
|
|
PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN
|
Professional
|
Both
|
$3,470.78
|
|
|
Service Code
|
HCPCS 26370
|
| Min. Negotiated Rate |
$644.30 |
| Max. Negotiated Rate |
$2,070.97 |
| Rate for Payer: Cash Price |
$934.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$920.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$828.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$874.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$920.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$874.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$920.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$690.32
|
| Rate for Payer: Healthfirst Commercial |
$920.43
|
| Rate for Payer: Healthfirst Essential Plan |
$2,070.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$874.41
|
| Rate for Payer: Healthfirst QHP |
$920.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$644.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$920.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$782.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$644.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$920.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$690.32
|
| Rate for Payer: SOMOS Essential |
$690.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$920.43
|
|
|
PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA
|
Professional
|
Both
|
$4,066.16
|
|
|
Service Code
|
HCPCS 26372
|
| Min. Negotiated Rate |
$753.09 |
| Max. Negotiated Rate |
$2,420.64 |
| Rate for Payer: Cash Price |
$1,094.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,075.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$968.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$968.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,022.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,075.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,022.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,075.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,075.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$806.88
|
| Rate for Payer: Healthfirst Commercial |
$1,075.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,420.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,022.05
|
| Rate for Payer: Healthfirst QHP |
$1,075.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$753.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,075.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$914.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$753.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,075.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$806.88
|
| Rate for Payer: SOMOS Essential |
$806.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,075.84
|
|
|
PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA
|
Professional
|
Both
|
$3,916.36
|
|
|
Service Code
|
HCPCS 26373
|
| Min. Negotiated Rate |
$724.73 |
| Max. Negotiated Rate |
$2,329.49 |
| Rate for Payer: Cash Price |
$1,053.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,035.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$931.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$931.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$983.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,035.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$983.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,035.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,035.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$776.50
|
| Rate for Payer: Healthfirst Commercial |
$1,035.33
|
| Rate for Payer: Healthfirst Essential Plan |
$2,329.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$983.56
|
| Rate for Payer: Healthfirst QHP |
$1,035.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$724.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,035.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$880.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$724.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,035.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$776.50
|
| Rate for Payer: SOMOS Essential |
$776.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,035.33
|
|
|
PR RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ
|
Professional
|
Both
|
$7,657.34
|
|
|
Service Code
|
HCPCS 33507
|
| Min. Negotiated Rate |
$1,408.38 |
| Max. Negotiated Rate |
$4,526.93 |
| Rate for Payer: Cash Price |
$2,032.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,011.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,810.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,810.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,911.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,011.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,911.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,011.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,011.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,508.98
|
| Rate for Payer: Healthfirst Commercial |
$2,011.97
|
| Rate for Payer: Healthfirst Essential Plan |
$4,526.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,911.37
|
| Rate for Payer: Healthfirst QHP |
$2,011.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,408.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,011.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,710.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,408.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,011.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,508.98
|
| Rate for Payer: SOMOS Essential |
$1,508.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,011.97
|
|
|
PR RPR ANOM CORON ART W/CONSTJ INTRAPULM ART TUNNEL
|
Professional
|
Both
|
$9,166.12
|
|
|
Service Code
|
HCPCS 33505
|
| Min. Negotiated Rate |
$1,680.36 |
| Max. Negotiated Rate |
$5,401.15 |
| Rate for Payer: Cash Price |
$2,429.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,400.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,160.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,160.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,280.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,400.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,280.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,400.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,400.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,800.38
|
| Rate for Payer: Healthfirst Commercial |
$2,400.51
|
| Rate for Payer: Healthfirst Essential Plan |
$5,401.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,280.48
|
| Rate for Payer: Healthfirst QHP |
$2,400.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,680.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,400.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,040.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,680.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,400.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,800.38
|
| Rate for Payer: SOMOS Essential |
$1,800.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,400.51
|
|
|
PR RPR ANOM CORONARY ARTERY PULM ART ORIGIN GRAFT
|
Professional
|
Both
|
$5,916.51
|
|
|
Service Code
|
HCPCS 33503
|
| Min. Negotiated Rate |
$1,096.03 |
| Max. Negotiated Rate |
$3,522.96 |
| Rate for Payer: Cash Price |
$1,578.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,565.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,409.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,409.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,487.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,565.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,487.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,565.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,565.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,174.32
|
| Rate for Payer: Healthfirst Commercial |
$1,565.76
|
| Rate for Payer: Healthfirst Essential Plan |
$3,522.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,487.47
|
| Rate for Payer: Healthfirst QHP |
$1,565.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,096.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,565.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,330.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,096.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,565.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,174.32
|
| Rate for Payer: SOMOS Essential |
$1,174.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,565.76
|
|
|
PR RPR ANOM CORONARY ART FROM PULM ART TO AORTA
|
Professional
|
Both
|
$9,125.20
|
|
|
Service Code
|
HCPCS 33506
|
| Min. Negotiated Rate |
$1,676.68 |
| Max. Negotiated Rate |
$5,389.34 |
| Rate for Payer: Cash Price |
$2,422.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,395.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,155.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,155.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,275.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,395.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,275.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,395.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,395.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,796.44
|
| Rate for Payer: Healthfirst Commercial |
$2,395.26
|
| Rate for Payer: Healthfirst Essential Plan |
$5,389.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,275.50
|
| Rate for Payer: Healthfirst QHP |
$2,395.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,676.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,395.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,035.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,676.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,395.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,796.44
|
| Rate for Payer: SOMOS Essential |
$1,796.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,395.26
|
|
|
PR RPR ANOM CORONARY ART PULM ART ORIGIN GRF W/BYP
|
Professional
|
Both
|
$6,529.43
|
|
|
Service Code
|
HCPCS 33504
|
| Min. Negotiated Rate |
$1,207.56 |
| Max. Negotiated Rate |
$3,881.45 |
| Rate for Payer: Cash Price |
$1,740.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,725.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,552.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,552.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,638.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,725.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,638.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,725.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,725.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,293.82
|
| Rate for Payer: Healthfirst Commercial |
$1,725.09
|
| Rate for Payer: Healthfirst Essential Plan |
$3,881.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,638.84
|
| Rate for Payer: Healthfirst QHP |
$1,725.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,207.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,725.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,466.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,207.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,725.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,293.82
|
| Rate for Payer: SOMOS Essential |
$1,293.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,725.09
|
|
|
PR RPR ANOM CORONARY ART PULM ART ORIGIN LIGATION
|
Professional
|
Both
|
$5,692.47
|
|
|
Service Code
|
HCPCS 33502
|
| Min. Negotiated Rate |
$1,053.74 |
| Max. Negotiated Rate |
$3,387.01 |
| Rate for Payer: Cash Price |
$1,518.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,505.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,354.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,354.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,430.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,505.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,430.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,505.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,505.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,129.01
|
| Rate for Payer: Healthfirst Commercial |
$1,505.34
|
| Rate for Payer: Healthfirst Essential Plan |
$3,387.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,430.07
|
| Rate for Payer: Healthfirst QHP |
$1,505.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,053.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,505.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,279.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,053.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,505.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,129.01
|
| Rate for Payer: SOMOS Essential |
$1,129.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,505.34
|
|
|
PR RPR ATRIAL SEPTAL DFCT SECUNDUM W/BYP W/WO PATCH
|
Professional
|
Both
|
$7,286.13
|
|
|
Service Code
|
HCPCS 33641
|
| Min. Negotiated Rate |
$1,342.47 |
| Max. Negotiated Rate |
$4,315.07 |
| Rate for Payer: Cash Price |
$1,937.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,917.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,726.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,726.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,821.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,917.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,821.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,917.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,917.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,438.36
|
| Rate for Payer: Healthfirst Commercial |
$1,917.81
|
| Rate for Payer: Healthfirst Essential Plan |
$4,315.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,821.92
|
| Rate for Payer: Healthfirst QHP |
$1,917.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,342.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,917.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,630.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,342.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,917.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,438.36
|
| Rate for Payer: SOMOS Essential |
$1,438.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,917.81
|
|
|
PR RPR ATRIAL & VENTRIC SEPTAL DFCT DIR/PATCH CLS
|
Professional
|
Both
|
$8,080.87
|
|
|
Service Code
|
HCPCS 33647
|
| Min. Negotiated Rate |
$1,486.07 |
| Max. Negotiated Rate |
$4,776.64 |
| Rate for Payer: Cash Price |
$2,145.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,122.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,910.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,910.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,016.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,122.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,016.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,122.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,122.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,592.21
|
| Rate for Payer: Healthfirst Commercial |
$2,122.95
|
| Rate for Payer: Healthfirst Essential Plan |
$4,776.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,016.80
|
| Rate for Payer: Healthfirst QHP |
$2,122.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,486.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,122.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,804.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,486.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,122.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,592.21
|
| Rate for Payer: SOMOS Essential |
$1,592.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,122.95
|
|
|
PR RPR BLEPHAROPT FRONTALIS MUSC AUTOL FASCAL SLING
|
Professional
|
Both
|
$2,983.33
|
|
|
Service Code
|
HCPCS 67902
|
| Min. Negotiated Rate |
$567.64 |
| Max. Negotiated Rate |
$1,824.57 |
| Rate for Payer: Cash Price |
$820.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$810.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$729.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$729.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$770.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$810.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$770.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$810.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$810.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$608.19
|
| Rate for Payer: Healthfirst Commercial |
$810.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,824.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$770.37
|
| Rate for Payer: Healthfirst QHP |
$810.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$567.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$810.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$689.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$567.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$810.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$608.19
|
| Rate for Payer: SOMOS Essential |
$608.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$810.92
|
|
|
PR RPR BLEPHAROPTOSIS FRONTALIS MUSC SUTR/OTH MATRL
|
Professional
|
Both
|
$2,442.48
|
|
|
Service Code
|
HCPCS 67901
|
| Min. Negotiated Rate |
$462.98 |
| Max. Negotiated Rate |
$1,488.15 |
| Rate for Payer: Cash Price |
$669.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$661.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$595.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$595.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$628.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$661.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$628.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$661.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$661.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$496.05
|
| Rate for Payer: Healthfirst Commercial |
$661.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,488.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$628.33
|
| Rate for Payer: Healthfirst QHP |
$661.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$462.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$661.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$562.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$462.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$661.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$496.05
|
| Rate for Payer: SOMOS Essential |
$496.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$661.40
|
|
|
PR RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL
|
Professional
|
Both
|
$1,974.11
|
|
|
Service Code
|
HCPCS 67903
|
| Min. Negotiated Rate |
$376.75 |
| Max. Negotiated Rate |
$1,210.97 |
| Rate for Payer: Cash Price |
$543.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$538.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$484.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$484.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$511.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$538.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$511.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$538.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$538.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$403.66
|
| Rate for Payer: Healthfirst Commercial |
$538.21
|
| Rate for Payer: Healthfirst Essential Plan |
$1,210.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$511.30
|
| Rate for Payer: Healthfirst QHP |
$538.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$376.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$538.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$457.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$376.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$538.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$403.66
|
| Rate for Payer: SOMOS Essential |
$403.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$538.21
|
|
|
PR RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL
|
Professional
|
Both
|
$2,453.89
|
|
|
Service Code
|
HCPCS 67904
|
| Min. Negotiated Rate |
$467.19 |
| Max. Negotiated Rate |
$1,501.69 |
| Rate for Payer: Cash Price |
$675.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$667.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$600.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$600.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$634.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$667.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$634.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$667.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$667.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$500.56
|
| Rate for Payer: Healthfirst Commercial |
$667.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,501.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$634.05
|
| Rate for Payer: Healthfirst QHP |
$667.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$467.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$667.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$567.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$467.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$667.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$500.56
|
| Rate for Payer: SOMOS Essential |
$500.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$667.42
|
|
|
PR RPR BLEPHAROPTOSIS SUPERIOR RECTUS FASCIAL SLING
|
Professional
|
Both
|
$2,075.15
|
|
|
Service Code
|
HCPCS 67906
|
| Min. Negotiated Rate |
$395.35 |
| Max. Negotiated Rate |
$1,270.76 |
| Rate for Payer: Cash Price |
$570.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$564.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$508.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$508.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$536.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$564.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$536.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$564.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$564.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$423.58
|
| Rate for Payer: Healthfirst Commercial |
$564.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,270.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$536.54
|
| Rate for Payer: Healthfirst QHP |
$564.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$395.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$564.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$480.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$395.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$564.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$423.58
|
| Rate for Payer: SOMOS Essential |
$423.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$564.78
|
|
|
PR RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL
|
Professional
|
Both
|
$6,574.51
|
|
|
Service Code
|
HCPCS 35221
|
| Min. Negotiated Rate |
$1,203.97 |
| Max. Negotiated Rate |
$3,869.91 |
| Rate for Payer: Cash Price |
$1,743.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,719.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,547.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,547.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,633.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,719.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,633.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,719.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,719.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,289.97
|
| Rate for Payer: Healthfirst Commercial |
$1,719.96
|
| Rate for Payer: Healthfirst Essential Plan |
$3,869.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,633.96
|
| Rate for Payer: Healthfirst QHP |
$1,719.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,203.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,719.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,461.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,203.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,719.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,289.97
|
| Rate for Payer: SOMOS Essential |
$1,289.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,719.96
|
|
|
PR RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS
|
Professional
|
Both
|
$6,150.06
|
|
|
Service Code
|
HCPCS 35211
|
| Min. Negotiated Rate |
$1,136.93 |
| Max. Negotiated Rate |
$3,654.43 |
| Rate for Payer: Cash Price |
$1,643.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,624.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,461.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,461.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,542.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,624.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,542.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,624.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,624.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,218.14
|
| Rate for Payer: Healthfirst Commercial |
$1,624.19
|
| Rate for Payer: Healthfirst Essential Plan |
$3,654.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,542.98
|
| Rate for Payer: Healthfirst QHP |
$1,624.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,136.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,624.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,380.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,136.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,624.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,218.14
|
| Rate for Payer: SOMOS Essential |
$1,218.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,624.19
|
|
|
PR RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS
|
Professional
|
Both
|
$9,287.32
|
|
|
Service Code
|
HCPCS 35216
|
| Min. Negotiated Rate |
$1,702.01 |
| Max. Negotiated Rate |
$5,470.74 |
| Rate for Payer: Cash Price |
$2,481.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,431.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,188.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,188.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,309.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,431.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,309.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,431.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,431.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,823.58
|
| Rate for Payer: Healthfirst Commercial |
$2,431.44
|
| Rate for Payer: Healthfirst Essential Plan |
$5,470.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,309.87
|
| Rate for Payer: Healthfirst QHP |
$2,431.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,702.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,431.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,066.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,702.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,431.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,823.58
|
| Rate for Payer: SOMOS Essential |
$1,823.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,431.44
|
|
|
PR RPR BLOOD VESSEL DIRECT LOWER EXTREMITY
|
Professional
|
Both
|
$3,694.11
|
|
|
Service Code
|
HCPCS 35226
|
| Min. Negotiated Rate |
$675.18 |
| Max. Negotiated Rate |
$2,170.22 |
| Rate for Payer: Cash Price |
$975.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$964.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$868.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$868.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$916.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$964.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$916.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$964.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$964.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$723.40
|
| Rate for Payer: Healthfirst Commercial |
$964.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,170.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$916.31
|
| Rate for Payer: Healthfirst QHP |
$964.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$675.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$964.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$819.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$675.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$964.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$723.40
|
| Rate for Payer: SOMOS Essential |
$723.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$964.54
|
|
|
PR RPR BLOOD VESSEL VEIN GRAFT INTRATHORACIC W/BYP
|
Professional
|
Both
|
$6,328.07
|
|
|
Service Code
|
HCPCS 35241
|
| Min. Negotiated Rate |
$1,167.33 |
| Max. Negotiated Rate |
$3,752.14 |
| Rate for Payer: Cash Price |
$1,682.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,667.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,500.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,500.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,584.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,667.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,584.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,667.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,667.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,250.71
|
| Rate for Payer: Healthfirst Commercial |
$1,667.62
|
| Rate for Payer: Healthfirst Essential Plan |
$3,752.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,584.24
|
| Rate for Payer: Healthfirst QHP |
$1,667.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,167.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,667.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,417.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,167.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,667.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,250.71
|
| Rate for Payer: SOMOS Essential |
$1,250.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,667.62
|
|
|
PR RPR BLOOD VESSEL VEIN GRF INTRATHORACIC W/O BYP
|
Professional
|
Both
|
$6,884.68
|
|
|
Service Code
|
HCPCS 35246
|
| Min. Negotiated Rate |
$1,270.29 |
| Max. Negotiated Rate |
$4,083.07 |
| Rate for Payer: Cash Price |
$1,829.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,814.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,633.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,633.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,723.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,814.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,723.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,814.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,814.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,361.03
|
| Rate for Payer: Healthfirst Commercial |
$1,814.70
|
| Rate for Payer: Healthfirst Essential Plan |
$4,083.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,723.96
|
| Rate for Payer: Healthfirst QHP |
$1,814.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,270.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,814.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,542.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,270.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,814.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,361.03
|
| Rate for Payer: SOMOS Essential |
$1,361.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,814.70
|
|
|
PR RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/BYP
|
Professional
|
Both
|
$6,141.00
|
|
|
Service Code
|
HCPCS 35271
|
| Min. Negotiated Rate |
$1,128.87 |
| Max. Negotiated Rate |
$3,628.51 |
| Rate for Payer: Cash Price |
$1,633.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,612.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,451.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,451.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,532.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,612.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,532.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,612.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,612.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,209.50
|
| Rate for Payer: Healthfirst Commercial |
$1,612.67
|
| Rate for Payer: Healthfirst Essential Plan |
$3,628.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,532.04
|
| Rate for Payer: Healthfirst QHP |
$1,612.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,128.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,612.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,370.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,128.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,612.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,209.50
|
| Rate for Payer: SOMOS Essential |
$1,209.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,612.67
|
|
|
PR RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/O BYP
|
Professional
|
Both
|
$6,426.11
|
|
|
Service Code
|
HCPCS 35276
|
| Min. Negotiated Rate |
$1,186.72 |
| Max. Negotiated Rate |
$3,814.45 |
| Rate for Payer: Cash Price |
$1,709.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,695.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,525.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,525.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,610.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,695.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,610.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,695.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,695.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,271.48
|
| Rate for Payer: Healthfirst Commercial |
$1,695.31
|
| Rate for Payer: Healthfirst Essential Plan |
$3,814.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,610.54
|
| Rate for Payer: Healthfirst QHP |
$1,695.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,186.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,695.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,441.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,186.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,695.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,271.48
|
| Rate for Payer: SOMOS Essential |
$1,271.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,695.31
|
|
