|
PR TAS CONGENITAL CARDIAC ANOMALIES ANY METHOD
|
Professional
|
Both
|
$3,306.52
|
|
|
Service Code
|
HCPCS 33741
|
| Min. Negotiated Rate |
$607.03 |
| Max. Negotiated Rate |
$1,951.15 |
| Rate for Payer: Cash Price |
$877.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$867.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$780.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$780.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$823.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$867.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$823.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$867.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$867.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$650.38
|
| Rate for Payer: Healthfirst Commercial |
$867.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,951.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$823.82
|
| Rate for Payer: Healthfirst QHP |
$867.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$607.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$867.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$737.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$607.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$867.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$650.38
|
| Rate for Payer: SOMOS Essential |
$650.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$867.18
|
|
|
PR TATTOOING INCL MICROPIGMENTATION 6.0 CM/<
|
Professional
|
Both
|
$469.74
|
|
|
Service Code
|
HCPCS 11920
|
| Min. Negotiated Rate |
$93.22 |
| Max. Negotiated Rate |
$299.63 |
| Rate for Payer: Cash Price |
$133.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$133.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$133.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.88
|
| Rate for Payer: Healthfirst Commercial |
$133.17
|
| Rate for Payer: Healthfirst Essential Plan |
$299.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.51
|
| Rate for Payer: Healthfirst QHP |
$133.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$133.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$133.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.88
|
| Rate for Payer: SOMOS Essential |
$99.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.17
|
|
|
PR TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM
|
Professional
|
Both
|
$570.36
|
|
|
Service Code
|
HCPCS 11921
|
| Min. Negotiated Rate |
$106.79 |
| Max. Negotiated Rate |
$343.26 |
| Rate for Payer: Cash Price |
$153.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$137.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$137.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$144.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$144.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.42
|
| Rate for Payer: Healthfirst Commercial |
$152.56
|
| Rate for Payer: Healthfirst Essential Plan |
$343.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$144.93
|
| Rate for Payer: Healthfirst QHP |
$152.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$152.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$129.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$106.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$114.42
|
| Rate for Payer: SOMOS Essential |
$114.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.56
|
|
|
PR TATTOOING INCL MICROPIGMENTATION EA 20.0 CM
|
Professional
|
Both
|
$128.98
|
|
|
Service Code
|
HCPCS 11922
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$73.55 |
| Rate for Payer: Cash Price |
$33.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.52
|
| Rate for Payer: Healthfirst Commercial |
$32.69
|
| Rate for Payer: Healthfirst Essential Plan |
$73.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.06
|
| Rate for Payer: Healthfirst QHP |
$32.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.52
|
| Rate for Payer: SOMOS Essential |
$24.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.69
|
|
|
PR TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE
|
Professional
|
Both
|
$3,642.52
|
|
|
Service Code
|
HCPCS 37218
|
| Min. Negotiated Rate |
$675.69 |
| Max. Negotiated Rate |
$2,171.86 |
| Rate for Payer: Cash Price |
$972.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$965.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$868.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$868.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$917.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$965.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$917.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$965.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$965.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$723.95
|
| Rate for Payer: Healthfirst Commercial |
$965.27
|
| Rate for Payer: Healthfirst Essential Plan |
$2,171.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$917.01
|
| Rate for Payer: Healthfirst QHP |
$965.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$675.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$965.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$820.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$675.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$965.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$723.95
|
| Rate for Payer: SOMOS Essential |
$723.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$965.27
|
|
|
PR TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE
|
Professional
|
Both
|
$4,811.14
|
|
|
Service Code
|
HCPCS 37217
|
| Min. Negotiated Rate |
$881.27 |
| Max. Negotiated Rate |
$2,832.66 |
| Rate for Payer: Cash Price |
$1,266.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,258.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,133.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,133.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,196.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,258.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,196.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,258.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,258.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$944.22
|
| Rate for Payer: Healthfirst Commercial |
$1,258.96
|
| Rate for Payer: Healthfirst Essential Plan |
$2,832.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,196.01
|
| Rate for Payer: Healthfirst QHP |
$1,258.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$881.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,258.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,070.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$881.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,258.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$944.22
|
| Rate for Payer: SOMOS Essential |
$944.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,258.96
|
|
|
PR TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR
|
Professional
|
Both
|
$1,463.42
|
|
|
Service Code
|
HCPCS 33289
|
| Min. Negotiated Rate |
$270.65 |
| Max. Negotiated Rate |
$869.94 |
| Rate for Payer: Cash Price |
$389.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$386.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$347.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$347.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$367.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$386.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$367.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$386.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$386.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.98
|
| Rate for Payer: Healthfirst Commercial |
$386.64
|
| Rate for Payer: Healthfirst Essential Plan |
$869.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$367.31
|
| Rate for Payer: Healthfirst QHP |
$386.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$386.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$328.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$386.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$289.98
|
| Rate for Payer: SOMOS Essential |
$289.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$386.64
|
|
|
PR TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG
|
Professional
|
Both
|
$2,118.73
|
|
|
Service Code
|
HCPCS 33274
|
| Min. Negotiated Rate |
$387.72 |
| Max. Negotiated Rate |
$1,246.23 |
| Rate for Payer: Cash Price |
$559.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$553.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$498.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$498.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$526.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$553.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$526.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$553.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$553.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$415.41
|
| Rate for Payer: Healthfirst Commercial |
$553.88
|
| Rate for Payer: Healthfirst Essential Plan |
$1,246.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.19
|
| Rate for Payer: Healthfirst QHP |
$553.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$387.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$553.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$470.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$387.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$553.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$415.41
|
| Rate for Payer: SOMOS Essential |
$415.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$553.88
|
|
|
PR TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ
|
Professional
|
Both
|
$4,417.11
|
|
|
Service Code
|
HCPCS 37215
|
| Min. Negotiated Rate |
$807.07 |
| Max. Negotiated Rate |
$2,594.14 |
| Rate for Payer: Cash Price |
$1,169.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,152.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,037.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,037.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,095.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,152.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,095.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,152.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,152.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$864.71
|
| Rate for Payer: Healthfirst Commercial |
$1,152.95
|
| Rate for Payer: Healthfirst Essential Plan |
$2,594.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,095.30
|
| Rate for Payer: Healthfirst QHP |
$1,152.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$807.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,152.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$980.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$807.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,152.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$864.71
|
| Rate for Payer: SOMOS Essential |
$864.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,152.95
|
|
|
PR TCAT MITRAL VALVE REPAIR ADDL PROSTHESIS
|
Professional
|
Both
|
$1,857.17
|
|
|
Service Code
|
HCPCS 33419
|
| Min. Negotiated Rate |
$341.93 |
| Max. Negotiated Rate |
$1,099.06 |
| Rate for Payer: Cash Price |
$493.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$439.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$464.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$464.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$488.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$488.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$366.35
|
| Rate for Payer: Healthfirst Commercial |
$488.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,099.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$464.05
|
| Rate for Payer: Healthfirst QHP |
$488.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$341.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$488.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$415.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$341.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$366.35
|
| Rate for Payer: SOMOS Essential |
$366.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.47
|
|
|
PR TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS
|
Professional
|
Both
|
$7,886.94
|
|
|
Service Code
|
HCPCS 33418
|
| Min. Negotiated Rate |
$1,457.43 |
| Max. Negotiated Rate |
$4,684.59 |
| Rate for Payer: Cash Price |
$2,106.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,082.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,873.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,873.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,977.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,082.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,977.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,082.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,082.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,561.53
|
| Rate for Payer: Healthfirst Commercial |
$2,082.04
|
| Rate for Payer: Healthfirst Essential Plan |
$4,684.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,977.94
|
| Rate for Payer: Healthfirst QHP |
$2,082.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,457.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,082.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,769.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,457.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,082.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,561.53
|
| Rate for Payer: SOMOS Essential |
$1,561.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,082.04
|
|
|
PR TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS
|
Professional
|
Both
|
$5,381.32
|
|
|
Service Code
|
HCPCS 61624
|
| Min. Negotiated Rate |
$990.31 |
| Max. Negotiated Rate |
$3,183.14 |
| Rate for Payer: Cash Price |
$1,423.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,414.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,273.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,273.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,343.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,414.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,343.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,414.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,414.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,061.05
|
| Rate for Payer: Healthfirst Commercial |
$1,414.73
|
| Rate for Payer: Healthfirst Essential Plan |
$3,183.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,343.99
|
| Rate for Payer: Healthfirst QHP |
$1,414.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$990.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,414.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,202.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$990.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,414.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,061.05
|
| Rate for Payer: SOMOS Essential |
$1,061.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,414.73
|
|
|
PR TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS
|
Professional
|
Both
|
$4,011.84
|
|
|
Service Code
|
HCPCS 61626
|
| Min. Negotiated Rate |
$752.53 |
| Max. Negotiated Rate |
$2,418.84 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,075.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$967.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$967.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,021.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,075.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,021.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,075.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,075.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$806.28
|
| Rate for Payer: Healthfirst Commercial |
$1,075.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,418.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,021.29
|
| Rate for Payer: Healthfirst QHP |
$1,075.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$752.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,075.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$913.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$752.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,075.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$806.28
|
| Rate for Payer: SOMOS Essential |
$806.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,075.04
|
|
|
PR TCAT PLACEMENT RADJ DLVR DEV SBSQ C IV BRACHYTX
|
Professional
|
Both
|
$704.41
|
|
|
Service Code
|
HCPCS 92974
|
| Min. Negotiated Rate |
$84.47 |
| Max. Negotiated Rate |
$416.02 |
| Rate for Payer: Amida Care Medicaid |
$84.47
|
| Rate for Payer: Cash Price |
$188.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.68
|
| Rate for Payer: Healthfirst Commercial |
$184.90
|
| Rate for Payer: Healthfirst Essential Plan |
$416.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.66
|
| Rate for Payer: Healthfirst QHP |
$184.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.68
|
| Rate for Payer: SOMOS Essential |
$138.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.90
|
|
|
PR TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD
|
Professional
|
Both
|
$6,787.55
|
|
|
Service Code
|
HCPCS 61635
|
| Min. Negotiated Rate |
$1,266.59 |
| Max. Negotiated Rate |
$4,071.20 |
| Rate for Payer: Cash Price |
$1,806.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,809.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,628.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,628.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,718.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,809.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,718.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,809.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,809.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,357.07
|
| Rate for Payer: Healthfirst Commercial |
$1,809.42
|
| Rate for Payer: Healthfirst Essential Plan |
$4,071.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,718.95
|
| Rate for Payer: Healthfirst QHP |
$1,809.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,266.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,809.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,538.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,266.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,809.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,357.07
|
| Rate for Payer: SOMOS Essential |
$1,357.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,809.42
|
|
|
PR TCAT PULMONARY VALVE IMPLANTATION PRQ APPROACH
|
Professional
|
Both
|
$5,943.84
|
|
|
Service Code
|
HCPCS 33477
|
| Min. Negotiated Rate |
$1,024.98 |
| Max. Negotiated Rate |
$3,294.59 |
| Rate for Payer: Cash Price |
$1,497.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,464.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,317.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,317.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,391.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,464.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,391.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,464.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,464.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,098.19
|
| Rate for Payer: Healthfirst Commercial |
$1,464.26
|
| Rate for Payer: Healthfirst Essential Plan |
$3,294.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,391.05
|
| Rate for Payer: Healthfirst QHP |
$1,464.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,024.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,464.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,244.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,024.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,464.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,098.19
|
| Rate for Payer: SOMOS Essential |
$1,098.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,464.26
|
|
|
PR TCAT REMOVAL PERM LEADLESS PM RIGHT VENTR W/IMG
|
Professional
|
Both
|
$2,219.07
|
|
|
Service Code
|
HCPCS 33275
|
| Min. Negotiated Rate |
$410.85 |
| Max. Negotiated Rate |
$1,320.59 |
| Rate for Payer: Cash Price |
$593.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$586.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$528.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$528.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$557.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$586.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$557.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$586.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$586.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$440.20
|
| Rate for Payer: Healthfirst Commercial |
$586.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,320.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$557.58
|
| Rate for Payer: Healthfirst QHP |
$586.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$410.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$586.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$498.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$410.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$586.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$440.20
|
| Rate for Payer: SOMOS Essential |
$440.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$586.93
|
|
|
PR TDAP VACCINE 7 YRS/> IM
|
Professional
|
Both
|
$152.46
|
|
|
Service Code
|
HCPCS 90715
|
| Min. Negotiated Rate |
$27.87 |
| Max. Negotiated Rate |
$89.57 |
| Rate for Payer: Cash Price |
$39.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.86
|
| Rate for Payer: Healthfirst Commercial |
$39.81
|
| Rate for Payer: Healthfirst Essential Plan |
$89.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.82
|
| Rate for Payer: Healthfirst QHP |
$39.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.86
|
| Rate for Payer: SOMOS Essential |
$29.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.81
|
|
|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN
|
Professional
|
Both
|
$2,749.25
|
|
|
Service Code
|
HCPCS 25310
|
| Min. Negotiated Rate |
$596.10 |
| Max. Negotiated Rate |
$1,916.03 |
| Rate for Payer: Cash Price |
$745.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$851.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$766.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$766.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$808.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$851.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$808.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$851.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$851.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$638.68
|
| Rate for Payer: Healthfirst Commercial |
$851.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,916.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$808.99
|
| Rate for Payer: Healthfirst QHP |
$851.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$596.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$851.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$723.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$596.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$851.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$638.68
|
| Rate for Payer: SOMOS Essential |
$638.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$851.57
|
|
|
PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR
|
Professional
|
Both
|
$3,173.63
|
|
|
Service Code
|
HCPCS 25312
|
| Min. Negotiated Rate |
$600.35 |
| Max. Negotiated Rate |
$1,929.69 |
| Rate for Payer: Cash Price |
$858.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$857.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$771.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$771.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$814.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$857.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$814.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$857.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$857.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$643.23
|
| Rate for Payer: Healthfirst Commercial |
$857.64
|
| Rate for Payer: Healthfirst Essential Plan |
$1,929.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$814.76
|
| Rate for Payer: Healthfirst QHP |
$857.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$600.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$857.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$728.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$600.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$857.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$643.23
|
| Rate for Payer: SOMOS Essential |
$643.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$857.64
|
|
|
PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE
|
Professional
|
Both
|
$116.43
|
|
|
Service Code
|
HCPCS 90714
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$84.08 |
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.03
|
| Rate for Payer: Healthfirst Commercial |
$37.37
|
| Rate for Payer: Healthfirst Essential Plan |
$84.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.50
|
| Rate for Payer: Healthfirst QHP |
$37.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.03
|
| Rate for Payer: SOMOS Essential |
$28.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.37
|
|
|
PR TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART
|
Professional
|
Both
|
$1,986.81
|
|
|
Service Code
|
HCPCS 35306
|
| Min. Negotiated Rate |
$361.93 |
| Max. Negotiated Rate |
$1,163.34 |
| Rate for Payer: Cash Price |
$522.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$517.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$465.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$465.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$491.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$517.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$491.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$517.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$517.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$387.78
|
| Rate for Payer: Healthfirst Commercial |
$517.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,163.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$491.19
|
| Rate for Payer: Healthfirst QHP |
$517.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$361.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$517.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$439.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$361.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$517.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$387.78
|
| Rate for Payer: SOMOS Essential |
$387.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$517.04
|
|
|
PR TEAEC W/GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$5,498.43
|
|
|
Service Code
|
HCPCS 35303
|
| Min. Negotiated Rate |
$997.44 |
| Max. Negotiated Rate |
$3,206.05 |
| Rate for Payer: Cash Price |
$1,441.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,424.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,282.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,282.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,353.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,424.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,353.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,424.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,424.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,068.68
|
| Rate for Payer: Healthfirst Commercial |
$1,424.91
|
| Rate for Payer: Healthfirst Essential Plan |
$3,206.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,353.66
|
| Rate for Payer: Healthfirst QHP |
$1,424.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$997.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,424.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,211.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$997.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,424.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,068.68
|
| Rate for Payer: SOMOS Essential |
$1,068.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,424.91
|
|
|
PR TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY
|
Professional
|
Both
|
$4,971.54
|
|
|
Service Code
|
HCPCS 35302
|
| Min. Negotiated Rate |
$907.70 |
| Max. Negotiated Rate |
$2,917.62 |
| Rate for Payer: Cash Price |
$1,314.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,296.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,167.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,167.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,231.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,296.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,231.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,296.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,296.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$972.54
|
| Rate for Payer: Healthfirst Commercial |
$1,296.72
|
| Rate for Payer: Healthfirst Essential Plan |
$2,917.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,231.88
|
| Rate for Payer: Healthfirst QHP |
$1,296.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$907.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,296.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,102.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$907.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,296.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$972.54
|
| Rate for Payer: SOMOS Essential |
$972.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,296.72
|
|
|
PR TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL
|
Professional
|
Both
|
$5,434.17
|
|
|
Service Code
|
HCPCS 35305
|
| Min. Negotiated Rate |
$995.20 |
| Max. Negotiated Rate |
$3,198.87 |
| Rate for Payer: Cash Price |
$1,444.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,421.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,279.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,279.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,350.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,421.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,350.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,421.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,421.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,066.29
|
| Rate for Payer: Healthfirst Commercial |
$1,421.72
|
| Rate for Payer: Healthfirst Essential Plan |
$3,198.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,350.63
|
| Rate for Payer: Healthfirst QHP |
$1,421.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$995.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,421.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,208.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$995.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,421.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,066.29
|
| Rate for Payer: SOMOS Essential |
$1,066.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,421.72
|
|
