|
PR RPR TGV AORTIC P-ART RCNSTJ RPR SBPULMC OBSTRCJ
|
Professional
|
Both
|
$10,277.30
|
|
|
Service Code
|
HCPCS 33781
|
| Min. Negotiated Rate |
$1,884.09 |
| Max. Negotiated Rate |
$6,055.99 |
| Rate for Payer: Cash Price |
$2,723.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,691.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,422.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,422.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,556.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,691.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,556.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,691.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,691.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,018.66
|
| Rate for Payer: Healthfirst Commercial |
$2,691.55
|
| Rate for Payer: Healthfirst Essential Plan |
$6,055.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,556.97
|
| Rate for Payer: Healthfirst QHP |
$2,691.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,884.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,691.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,287.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,884.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,691.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,018.66
|
| Rate for Payer: SOMOS Essential |
$2,018.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,691.55
|
|
|
PR RPR TGV AORTIC P-ART RCNSTJ W/CLSR V-SEPTL DFCT
|
Professional
|
Both
|
$10,525.34
|
|
|
Service Code
|
HCPCS 33780
|
| Min. Negotiated Rate |
$1,932.53 |
| Max. Negotiated Rate |
$6,211.71 |
| Rate for Payer: Cash Price |
$2,791.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,760.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,484.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,484.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,622.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,760.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,622.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,760.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,760.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,070.57
|
| Rate for Payer: Healthfirst Commercial |
$2,760.76
|
| Rate for Payer: Healthfirst Essential Plan |
$6,211.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,622.72
|
| Rate for Payer: Healthfirst QHP |
$2,760.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,932.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,760.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,346.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,932.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,760.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,070.57
|
| Rate for Payer: SOMOS Essential |
$2,070.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,760.76
|
|
|
PR RPR TGV AORTIC PULM ART RCNSTJ W/RMVL PULM BAND
|
Professional
|
Both
|
$10,331.55
|
|
|
Service Code
|
HCPCS 33779
|
| Min. Negotiated Rate |
$1,895.43 |
| Max. Negotiated Rate |
$6,092.46 |
| Rate for Payer: Cash Price |
$2,739.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,707.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,436.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,436.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,572.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,707.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,572.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,707.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,707.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,030.82
|
| Rate for Payer: Healthfirst Commercial |
$2,707.76
|
| Rate for Payer: Healthfirst Essential Plan |
$6,092.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,572.37
|
| Rate for Payer: Healthfirst QHP |
$2,707.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,895.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,707.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,301.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,895.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,707.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,030.82
|
| Rate for Payer: SOMOS Essential |
$2,030.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,707.76
|
|
|
PR RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS
|
Professional
|
Both
|
$15,990.94
|
|
|
Service Code
|
HCPCS 33877
|
| Min. Negotiated Rate |
$2,933.96 |
| Max. Negotiated Rate |
$9,430.58 |
| Rate for Payer: Cash Price |
$4,236.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,191.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,772.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,772.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,981.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,191.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,981.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,191.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,191.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,143.53
|
| Rate for Payer: Healthfirst Commercial |
$4,191.37
|
| Rate for Payer: Healthfirst Essential Plan |
$9,430.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,981.80
|
| Rate for Payer: Healthfirst QHP |
$4,191.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,933.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,191.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,562.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,933.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,191.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,143.53
|
| Rate for Payer: SOMOS Essential |
$3,143.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,191.37
|
|
|
PR RPR/TRAUMATIC AV FISTULA EXTREMITIES
|
Professional
|
Both
|
$3,395.21
|
|
|
Service Code
|
HCPCS 35190
|
| Min. Negotiated Rate |
$617.09 |
| Max. Negotiated Rate |
$1,983.51 |
| Rate for Payer: Cash Price |
$894.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$881.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$793.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$793.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$837.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$881.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$837.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$881.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$881.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$661.17
|
| Rate for Payer: Healthfirst Commercial |
$881.56
|
| Rate for Payer: Healthfirst Essential Plan |
$1,983.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$837.48
|
| Rate for Payer: Healthfirst QHP |
$881.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$617.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$881.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$749.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$617.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$881.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$661.17
|
| Rate for Payer: SOMOS Essential |
$661.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$881.56
|
|
|
PR RPR/TRAUMATIC AV FISTULA HEAD & NECK
|
Professional
|
Both
|
$6,181.28
|
|
|
Service Code
|
HCPCS 35188
|
| Min. Negotiated Rate |
$1,131.34 |
| Max. Negotiated Rate |
$3,636.45 |
| Rate for Payer: Cash Price |
$1,632.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,616.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,454.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,454.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,535.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,616.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,535.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,616.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,616.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,212.15
|
| Rate for Payer: Healthfirst Commercial |
$1,616.20
|
| Rate for Payer: Healthfirst Essential Plan |
$3,636.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,535.39
|
| Rate for Payer: Healthfirst QHP |
$1,616.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,131.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,616.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,373.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,131.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,616.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,212.15
|
| Rate for Payer: SOMOS Essential |
$1,212.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,616.20
|
|
|
PR RPR/TRAUMATIC AV FISTULA THORAX & ABDOMEN
|
Professional
|
Both
|
$6,713.14
|
|
|
Service Code
|
HCPCS 35189
|
| Min. Negotiated Rate |
$1,230.52 |
| Max. Negotiated Rate |
$3,955.25 |
| Rate for Payer: Cash Price |
$1,779.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,757.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,582.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,582.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,670.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,757.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,670.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,757.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,757.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,318.42
|
| Rate for Payer: Healthfirst Commercial |
$1,757.89
|
| Rate for Payer: Healthfirst Essential Plan |
$3,955.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,670.00
|
| Rate for Payer: Healthfirst QHP |
$1,757.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,230.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,757.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,494.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,230.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,757.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,318.42
|
| Rate for Payer: SOMOS Essential |
$1,318.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,757.89
|
|
|
PR RPR TRPOS GREAT VSLS ATR BAFFLE W/RMVL PULM BAND
|
Professional
|
Both
|
$8,256.43
|
|
|
Service Code
|
HCPCS 33775
|
| Min. Negotiated Rate |
$1,521.15 |
| Max. Negotiated Rate |
$4,889.41 |
| Rate for Payer: Cash Price |
$2,194.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,173.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,955.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,955.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,064.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,173.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,064.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,173.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,173.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,629.80
|
| Rate for Payer: Healthfirst Commercial |
$2,173.07
|
| Rate for Payer: Healthfirst Essential Plan |
$4,889.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,064.42
|
| Rate for Payer: Healthfirst QHP |
$2,173.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,521.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,173.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,847.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,521.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,173.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,629.80
|
| Rate for Payer: SOMOS Essential |
$1,629.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,173.07
|
|
|
PR RPR TRPOS GREAT VSLS ATRIAL BAFFLE PX W/BYPASS
|
Professional
|
Both
|
$8,015.25
|
|
|
Service Code
|
HCPCS 33774
|
| Min. Negotiated Rate |
$1,478.60 |
| Max. Negotiated Rate |
$4,752.63 |
| Rate for Payer: Cash Price |
$2,132.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,112.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,901.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,901.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,006.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,112.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,006.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,112.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,112.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,584.21
|
| Rate for Payer: Healthfirst Commercial |
$2,112.28
|
| Rate for Payer: Healthfirst Essential Plan |
$4,752.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,006.67
|
| Rate for Payer: Healthfirst QHP |
$2,112.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,478.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,112.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,795.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,478.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,112.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,584.21
|
| Rate for Payer: SOMOS Essential |
$1,584.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,112.28
|
|
|
PR RPR TRPOS GREAT VSLS W/ENLGMNT V-SEPTL DFCT
|
Professional
|
Both
|
$9,682.30
|
|
|
Service Code
|
HCPCS 33771
|
| Min. Negotiated Rate |
$1,775.48 |
| Max. Negotiated Rate |
$5,706.90 |
| Rate for Payer: Cash Price |
$2,566.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,536.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,282.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,282.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,409.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,536.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,409.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,536.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,536.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,902.30
|
| Rate for Payer: Healthfirst Commercial |
$2,536.40
|
| Rate for Payer: Healthfirst Essential Plan |
$5,706.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,409.58
|
| Rate for Payer: Healthfirst QHP |
$2,536.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,775.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,536.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,155.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,775.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,536.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,902.30
|
| Rate for Payer: SOMOS Essential |
$1,902.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,536.40
|
|
|
PR RPR TRPOS GREAT VSLS W/O ENLGMNT V-SEPTL DFCT
|
Professional
|
Both
|
$9,408.95
|
|
|
Service Code
|
HCPCS 33770
|
| Min. Negotiated Rate |
$1,727.46 |
| Max. Negotiated Rate |
$5,552.55 |
| Rate for Payer: Cash Price |
$2,496.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,467.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,221.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,221.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,344.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,467.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,344.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,467.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,467.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,850.85
|
| Rate for Payer: Healthfirst Commercial |
$2,467.80
|
| Rate for Payer: Healthfirst Essential Plan |
$5,552.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,344.41
|
| Rate for Payer: Healthfirst QHP |
$2,467.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,727.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,467.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,097.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,727.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,467.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,850.85
|
| Rate for Payer: SOMOS Essential |
$1,850.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,467.80
|
|
|
PR RPR TRPOS GRT VESSEL AORTIC PULMONARY ART RCNSTJ
|
Professional
|
Both
|
$10,454.22
|
|
|
Service Code
|
HCPCS 33778
|
| Min. Negotiated Rate |
$1,922.68 |
| Max. Negotiated Rate |
$6,180.05 |
| Rate for Payer: Cash Price |
$2,778.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,746.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,472.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,472.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,609.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,746.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,609.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,746.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,746.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,060.02
|
| Rate for Payer: Healthfirst Commercial |
$2,746.69
|
| Rate for Payer: Healthfirst Essential Plan |
$6,180.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,609.36
|
| Rate for Payer: Healthfirst QHP |
$2,746.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,922.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,746.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,334.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,922.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,746.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,060.02
|
| Rate for Payer: SOMOS Essential |
$2,060.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,746.69
|
|
|
PR RPR TRPOS GRT VSL ATR BAFFLE W/BYP SBPULM OBSTRC
|
Professional
|
Both
|
$8,415.02
|
|
|
Service Code
|
HCPCS 33777
|
| Min. Negotiated Rate |
$1,548.46 |
| Max. Negotiated Rate |
$4,977.18 |
| Rate for Payer: Cash Price |
$2,235.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,212.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,990.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,990.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,101.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,212.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,101.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,212.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,212.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,659.06
|
| Rate for Payer: Healthfirst Commercial |
$2,212.08
|
| Rate for Payer: Healthfirst Essential Plan |
$4,977.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,101.48
|
| Rate for Payer: Healthfirst QHP |
$2,212.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,548.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,212.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,880.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,548.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,212.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,659.06
|
| Rate for Payer: SOMOS Essential |
$1,659.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,212.08
|
|
|
PR RPR TRPOS GRT VSL ATR BAFFLE W/CLSR V-SEPTL DFCT
|
Professional
|
Both
|
$8,722.74
|
|
|
Service Code
|
HCPCS 33776
|
| Min. Negotiated Rate |
$1,608.82 |
| Max. Negotiated Rate |
$5,171.22 |
| Rate for Payer: Cash Price |
$2,322.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,298.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,068.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,068.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,183.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,298.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,183.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,298.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,298.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,723.74
|
| Rate for Payer: Healthfirst Commercial |
$2,298.32
|
| Rate for Payer: Healthfirst Essential Plan |
$5,171.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,183.40
|
| Rate for Payer: Healthfirst QHP |
$2,298.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,608.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,298.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,953.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,608.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,298.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,723.74
|
| Rate for Payer: SOMOS Essential |
$1,723.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,298.32
|
|
|
PR RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE
|
Professional
|
Both
|
$1,605.10
|
|
|
Service Code
|
HCPCS 55060
|
| Min. Negotiated Rate |
$306.45 |
| Max. Negotiated Rate |
$985.00 |
| Rate for Payer: Cash Price |
$440.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$437.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$394.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$394.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$415.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$437.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$415.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$437.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$437.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$328.33
|
| Rate for Payer: Healthfirst Commercial |
$437.78
|
| Rate for Payer: Healthfirst Essential Plan |
$985.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.89
|
| Rate for Payer: Healthfirst QHP |
$437.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$306.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$437.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$372.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$306.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$437.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$328.33
|
| Rate for Payer: SOMOS Essential |
$328.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$437.78
|
|
|
PR RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$137.59
|
|
|
Service Code
|
HCPCS 36575
|
| Min. Negotiated Rate |
$25.98 |
| Max. Negotiated Rate |
$83.50 |
| Rate for Payer: Cash Price |
$37.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.83
|
| Rate for Payer: Healthfirst Commercial |
$37.11
|
| Rate for Payer: Healthfirst Essential Plan |
$83.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.25
|
| Rate for Payer: Healthfirst QHP |
$37.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.83
|
| Rate for Payer: SOMOS Essential |
$27.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.11
|
|
|
PR RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC
|
Professional
|
Both
|
$9,549.19
|
|
|
Service Code
|
HCPCS 33414
|
| Min. Negotiated Rate |
$1,755.98 |
| Max. Negotiated Rate |
$5,644.22 |
| Rate for Payer: Cash Price |
$2,536.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,508.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,257.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,257.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,383.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,508.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,383.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,508.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,508.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,881.40
|
| Rate for Payer: Healthfirst Commercial |
$2,508.54
|
| Rate for Payer: Healthfirst Essential Plan |
$5,644.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,383.11
|
| Rate for Payer: Healthfirst QHP |
$2,508.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,755.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,508.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,132.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,755.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,508.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,881.40
|
| Rate for Payer: SOMOS Essential |
$1,881.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,508.54
|
|
|
PR RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSU
|
Professional
|
Both
|
$2,016.98
|
|
|
Service Code
|
HCPCS 65290
|
| Min. Negotiated Rate |
$382.23 |
| Max. Negotiated Rate |
$1,228.59 |
| Rate for Payer: Cash Price |
$554.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$546.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$491.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$491.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$518.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$546.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$518.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$546.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$546.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$409.53
|
| Rate for Payer: Healthfirst Commercial |
$546.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,228.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$518.74
|
| Rate for Payer: Healthfirst QHP |
$546.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$382.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$546.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$464.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$382.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$546.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$409.53
|
| Rate for Payer: SOMOS Essential |
$409.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$546.04
|
|
|
PR RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER
|
Professional
|
Both
|
$3,546.69
|
|
|
Service Code
|
HCPCS 26428
|
| Min. Negotiated Rate |
$656.94 |
| Max. Negotiated Rate |
$2,111.60 |
| Rate for Payer: Cash Price |
$954.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$938.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$844.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$844.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$891.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$938.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$891.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$938.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$938.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$703.87
|
| Rate for Payer: Healthfirst Commercial |
$938.49
|
| Rate for Payer: Healthfirst Essential Plan |
$2,111.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.57
|
| Rate for Payer: Healthfirst QHP |
$938.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$656.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$938.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$797.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$656.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$938.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$703.87
|
| Rate for Payer: SOMOS Essential |
$703.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$938.49
|
|
|
PR RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR
|
Professional
|
Both
|
$2,234.26
|
|
|
Service Code
|
HCPCS 26426
|
| Min. Negotiated Rate |
$423.81 |
| Max. Negotiated Rate |
$1,362.26 |
| Rate for Payer: Cash Price |
$607.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$605.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$544.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$544.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$575.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$605.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$575.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$605.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$605.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$454.09
|
| Rate for Payer: Healthfirst Commercial |
$605.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,362.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$575.18
|
| Rate for Payer: Healthfirst QHP |
$605.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$423.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$605.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$514.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$423.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$605.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$454.09
|
| Rate for Payer: SOMOS Essential |
$454.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$605.45
|
|
|
PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD
|
Professional
|
Both
|
$2,155.86
|
|
|
Service Code
|
HCPCS 33226
|
| Min. Negotiated Rate |
$396.61 |
| Max. Negotiated Rate |
$1,274.81 |
| Rate for Payer: Cash Price |
$572.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$566.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$509.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$509.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$538.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$566.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$538.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$566.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$566.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$424.94
|
| Rate for Payer: Healthfirst Commercial |
$566.58
|
| Rate for Payer: Healthfirst Essential Plan |
$1,274.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$538.25
|
| Rate for Payer: Healthfirst QHP |
$566.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$396.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$566.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$481.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$396.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$566.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$424.94
|
| Rate for Payer: SOMOS Essential |
$424.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$566.58
|
|
|
PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Professional
|
Both
|
$1,372.74
|
|
|
Service Code
|
HCPCS 33215
|
| Min. Negotiated Rate |
$253.24 |
| Max. Negotiated Rate |
$813.98 |
| Rate for Payer: Cash Price |
$364.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$361.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$325.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$325.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$343.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$361.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$343.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$361.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$361.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$271.33
|
| Rate for Payer: Healthfirst Commercial |
$361.77
|
| Rate for Payer: Healthfirst Essential Plan |
$813.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$343.68
|
| Rate for Payer: Healthfirst QHP |
$361.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$253.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$361.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$307.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$253.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$361.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$271.33
|
| Rate for Payer: SOMOS Essential |
$271.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$361.77
|
|
|
PR RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE
|
Professional
|
Both
|
$257.01
|
|
|
Service Code
|
HCPCS 36597
|
| Min. Negotiated Rate |
$47.24 |
| Max. Negotiated Rate |
$151.85 |
| Rate for Payer: Cash Price |
$67.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.62
|
| Rate for Payer: Healthfirst Commercial |
$67.49
|
| Rate for Payer: Healthfirst Essential Plan |
$151.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.12
|
| Rate for Payer: Healthfirst QHP |
$67.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.62
|
| Rate for Payer: SOMOS Essential |
$50.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.49
|
|
|
PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I
|
Professional
|
Both
|
$1,448.93
|
|
|
Service Code
|
HCPCS 37193
|
| Min. Negotiated Rate |
$270.40 |
| Max. Negotiated Rate |
$869.13 |
| Rate for Payer: Cash Price |
$389.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$386.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$347.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$347.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$366.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$386.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$366.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$386.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$386.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.71
|
| Rate for Payer: Healthfirst Commercial |
$386.28
|
| Rate for Payer: Healthfirst Essential Plan |
$869.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$366.97
|
| Rate for Payer: Healthfirst QHP |
$386.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$386.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$328.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$386.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$289.71
|
| Rate for Payer: SOMOS Essential |
$289.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$386.28
|
|
|
PR R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY
|
Professional
|
Both
|
$6,785.31
|
|
|
Service Code
|
HCPCS 33476
|
| Min. Negotiated Rate |
$1,253.19 |
| Max. Negotiated Rate |
$4,028.11 |
| Rate for Payer: Cash Price |
$1,807.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,790.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,611.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,611.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,700.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,790.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,700.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,790.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,790.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,342.70
|
| Rate for Payer: Healthfirst Commercial |
$1,790.27
|
| Rate for Payer: Healthfirst Essential Plan |
$4,028.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,700.76
|
| Rate for Payer: Healthfirst QHP |
$1,790.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,253.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,790.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,521.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,253.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,790.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,342.70
|
| Rate for Payer: SOMOS Essential |
$1,342.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,790.27
|
|
