|
PR TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY
|
Professional
|
Both
|
$5,651.98
|
|
|
Service Code
|
HCPCS 35304
|
| Min. Negotiated Rate |
$1,037.20 |
| Max. Negotiated Rate |
$3,333.87 |
| Rate for Payer: Cash Price |
$1,501.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,481.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,333.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,333.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,407.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,481.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,407.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,481.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,481.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,111.29
|
| Rate for Payer: Healthfirst Commercial |
$1,481.72
|
| Rate for Payer: Healthfirst Essential Plan |
$3,333.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,407.63
|
| Rate for Payer: Healthfirst QHP |
$1,481.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,037.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,481.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,259.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,037.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,481.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,111.29
|
| Rate for Payer: SOMOS Essential |
$1,111.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,481.72
|
|
|
PR TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC
|
Professional
|
Both
|
$5,030.31
|
|
|
Service Code
|
HCPCS 35301
|
| Min. Negotiated Rate |
$920.55 |
| Max. Negotiated Rate |
$2,958.91 |
| Rate for Payer: Cash Price |
$1,331.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,315.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,183.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,183.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,249.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,315.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,249.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,315.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,315.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$986.30
|
| Rate for Payer: Healthfirst Commercial |
$1,315.07
|
| Rate for Payer: Healthfirst Essential Plan |
$2,958.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,249.32
|
| Rate for Payer: Healthfirst QHP |
$1,315.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$920.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,315.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,117.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$920.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,315.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$986.30
|
| Rate for Payer: SOMOS Essential |
$986.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,315.07
|
|
|
PR TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA
|
Professional
|
Both
|
$6,489.63
|
|
|
Service Code
|
HCPCS 35331
|
| Min. Negotiated Rate |
$1,177.51 |
| Max. Negotiated Rate |
$3,784.84 |
| Rate for Payer: Cash Price |
$1,712.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,682.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,513.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,513.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,598.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,682.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,598.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,682.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,682.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,261.61
|
| Rate for Payer: Healthfirst Commercial |
$1,682.15
|
| Rate for Payer: Healthfirst Essential Plan |
$3,784.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,598.04
|
| Rate for Payer: Healthfirst QHP |
$1,682.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,177.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,682.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,429.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,177.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,682.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,261.61
|
| Rate for Payer: SOMOS Essential |
$1,261.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,682.15
|
|
|
PR TEAEC W/WO PATCH GRAFT COMBINED AORTOILIAC
|
Professional
|
Both
|
$6,774.81
|
|
|
Service Code
|
HCPCS 35361
|
| Min. Negotiated Rate |
$1,241.35 |
| Max. Negotiated Rate |
$3,990.04 |
| Rate for Payer: Cash Price |
$1,794.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,773.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,596.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,596.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,684.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,773.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,684.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,773.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,773.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,330.01
|
| Rate for Payer: Healthfirst Commercial |
$1,773.35
|
| Rate for Payer: Healthfirst Essential Plan |
$3,990.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,684.68
|
| Rate for Payer: Healthfirst QHP |
$1,773.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,241.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,773.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,507.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,241.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,773.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,330.01
|
| Rate for Payer: SOMOS Essential |
$1,330.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,773.35
|
|
|
PR TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL
|
Professional
|
Both
|
$7,220.57
|
|
|
Service Code
|
HCPCS 35363
|
| Min. Negotiated Rate |
$1,324.99 |
| Max. Negotiated Rate |
$4,258.89 |
| Rate for Payer: Cash Price |
$1,912.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,892.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,703.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,703.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,798.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,892.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,798.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,892.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,892.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,419.63
|
| Rate for Payer: Healthfirst Commercial |
$1,892.84
|
| Rate for Payer: Healthfirst Essential Plan |
$4,258.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,798.20
|
| Rate for Payer: Healthfirst QHP |
$1,892.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,324.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,892.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,608.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,324.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,892.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,419.63
|
| Rate for Payer: SOMOS Essential |
$1,419.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,892.84
|
|
|
PR TEAEC W/WO PATCH GRAFT COMMON FEMORAL
|
Professional
|
Both
|
$3,619.95
|
|
|
Service Code
|
HCPCS 35371
|
| Min. Negotiated Rate |
$662.85 |
| Max. Negotiated Rate |
$2,130.59 |
| Rate for Payer: Cash Price |
$958.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$946.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$852.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$852.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$899.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$946.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$899.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$946.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$710.20
|
| Rate for Payer: Healthfirst Commercial |
$946.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,130.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$899.58
|
| Rate for Payer: Healthfirst QHP |
$946.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$662.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$946.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$804.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$662.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$946.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$710.20
|
| Rate for Payer: SOMOS Essential |
$710.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$946.93
|
|
|
PR TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL
|
Professional
|
Both
|
$4,336.08
|
|
|
Service Code
|
HCPCS 35372
|
| Min. Negotiated Rate |
$792.95 |
| Max. Negotiated Rate |
$2,548.78 |
| Rate for Payer: Cash Price |
$1,148.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,132.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,019.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,019.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,076.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,132.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,076.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,132.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,132.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$849.59
|
| Rate for Payer: Healthfirst Commercial |
$1,132.79
|
| Rate for Payer: Healthfirst Essential Plan |
$2,548.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,076.15
|
| Rate for Payer: Healthfirst QHP |
$1,132.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$792.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,132.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$962.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$792.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,132.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$849.59
|
| Rate for Payer: SOMOS Essential |
$849.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,132.79
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIAC
|
Professional
|
Both
|
$5,701.22
|
|
|
Service Code
|
HCPCS 35351
|
| Min. Negotiated Rate |
$1,048.04 |
| Max. Negotiated Rate |
$3,368.70 |
| Rate for Payer: Cash Price |
$1,512.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,497.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,347.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,347.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,422.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,497.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,422.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,497.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,497.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,122.90
|
| Rate for Payer: Healthfirst Commercial |
$1,497.20
|
| Rate for Payer: Healthfirst Essential Plan |
$3,368.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,422.34
|
| Rate for Payer: Healthfirst QHP |
$1,497.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,048.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,497.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,272.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,048.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,497.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,122.90
|
| Rate for Payer: SOMOS Essential |
$1,122.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,497.20
|
|
|
PR TEAEC W/WO PATCH GRAFT ILIOFEMORAL
|
Professional
|
Both
|
$4,569.85
|
|
|
Service Code
|
HCPCS 35355
|
| Min. Negotiated Rate |
$837.22 |
| Max. Negotiated Rate |
$2,691.07 |
| Rate for Payer: Cash Price |
$1,209.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,196.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,076.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,076.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,136.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,196.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,136.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,196.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,196.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$897.02
|
| Rate for Payer: Healthfirst Commercial |
$1,196.03
|
| Rate for Payer: Healthfirst Essential Plan |
$2,691.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,136.23
|
| Rate for Payer: Healthfirst QHP |
$1,196.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$837.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,196.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,016.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$837.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,196.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$897.02
|
| Rate for Payer: SOMOS Essential |
$897.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,196.03
|
|
|
PR TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL
|
Professional
|
Both
|
$6,141.49
|
|
|
Service Code
|
HCPCS 35341
|
| Min. Negotiated Rate |
$1,120.99 |
| Max. Negotiated Rate |
$3,603.17 |
| Rate for Payer: Cash Price |
$1,631.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,601.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,441.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,441.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,521.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,601.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,521.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,601.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,601.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,201.06
|
| Rate for Payer: Healthfirst Commercial |
$1,601.41
|
| Rate for Payer: Healthfirst Essential Plan |
$3,603.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,521.34
|
| Rate for Payer: Healthfirst QHP |
$1,601.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,120.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,601.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,361.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,120.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,601.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,201.06
|
| Rate for Payer: SOMOS Essential |
$1,201.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,601.41
|
|
|
PR TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL
|
Professional
|
Both
|
$3,978.77
|
|
|
Service Code
|
HCPCS 35321
|
| Min. Negotiated Rate |
$740.97 |
| Max. Negotiated Rate |
$2,381.69 |
| Rate for Payer: Cash Price |
$1,059.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,058.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$952.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$952.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,005.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,058.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,005.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,058.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,058.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$793.90
|
| Rate for Payer: Healthfirst Commercial |
$1,058.53
|
| Rate for Payer: Healthfirst Essential Plan |
$2,381.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,005.60
|
| Rate for Payer: Healthfirst QHP |
$1,058.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$740.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,058.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$899.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$740.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,058.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$793.90
|
| Rate for Payer: SOMOS Essential |
$793.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,058.53
|
|
|
PR TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC
|
Professional
|
Both
|
$6,851.99
|
|
|
Service Code
|
HCPCS 35311
|
| Min. Negotiated Rate |
$1,260.13 |
| Max. Negotiated Rate |
$4,050.41 |
| Rate for Payer: Cash Price |
$1,817.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,800.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,620.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,620.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,710.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,800.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,710.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,800.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,800.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,350.13
|
| Rate for Payer: Healthfirst Commercial |
$1,800.18
|
| Rate for Payer: Healthfirst Essential Plan |
$4,050.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,710.17
|
| Rate for Payer: Healthfirst QHP |
$1,800.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,260.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,800.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,530.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,260.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,800.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,350.13
|
| Rate for Payer: SOMOS Essential |
$1,350.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,800.18
|
|
|
PR TELEHEALTH INPT PHARM MGMT
|
Professional
|
Both
|
$164.43
|
|
|
Service Code
|
HCPCS G0459
|
| Min. Negotiated Rate |
$31.83 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Amida Care Medicaid |
$31.83
|
| Rate for Payer: Cash Price |
$46.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.59
|
| Rate for Payer: Healthfirst Commercial |
$47.46
|
| Rate for Payer: Healthfirst Essential Plan |
$106.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.09
|
| Rate for Payer: Healthfirst QHP |
$47.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.59
|
| Rate for Payer: SOMOS Essential |
$35.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.46
|
|
|
PR TELHEALTH INPT CONSULT 15MIN
|
Professional
|
Both
|
$175.74
|
|
|
Service Code
|
HCPCS G0406
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$103.23 |
| Rate for Payer: Amida Care Medicaid |
$29.75
|
| Rate for Payer: Cash Price |
$47.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.41
|
| Rate for Payer: Healthfirst Commercial |
$45.88
|
| Rate for Payer: Healthfirst Essential Plan |
$103.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.59
|
| Rate for Payer: Healthfirst QHP |
$45.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.41
|
| Rate for Payer: SOMOS Essential |
$34.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.88
|
|
|
PR TELHEALTH INPT CONSULT 35MIN
|
Professional
|
Both
|
$434.88
|
|
|
Service Code
|
HCPCS G0408
|
| Min. Negotiated Rate |
$78.06 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Amida Care Medicaid |
$78.06
|
| Rate for Payer: Cash Price |
$117.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.21
|
| Rate for Payer: Healthfirst Commercial |
$116.28
|
| Rate for Payer: Healthfirst Essential Plan |
$261.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.47
|
| Rate for Payer: Healthfirst QHP |
$116.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.21
|
| Rate for Payer: SOMOS Essential |
$87.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.28
|
|
|
PR TELHEATH INPT CONSULT 25MIN
|
Professional
|
Both
|
$297.50
|
|
|
Service Code
|
HCPCS G0407
|
| Min. Negotiated Rate |
$54.36 |
| Max. Negotiated Rate |
$181.71 |
| Rate for Payer: Amida Care Medicaid |
$54.36
|
| Rate for Payer: Cash Price |
$80.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.57
|
| Rate for Payer: Healthfirst Commercial |
$80.76
|
| Rate for Payer: Healthfirst Essential Plan |
$181.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.72
|
| Rate for Payer: Healthfirst QHP |
$80.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.57
|
| Rate for Payer: SOMOS Essential |
$60.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.76
|
|
|
PR TEMPORARY CLOSURE EYELIDS SUTURE
|
Professional
|
Both
|
$393.12
|
|
|
Service Code
|
HCPCS 67875
|
| Min. Negotiated Rate |
$75.68 |
| Max. Negotiated Rate |
$243.25 |
| Rate for Payer: Cash Price |
$108.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$108.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$97.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$108.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.08
|
| Rate for Payer: Healthfirst Commercial |
$108.11
|
| Rate for Payer: Healthfirst Essential Plan |
$243.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.70
|
| Rate for Payer: Healthfirst QHP |
$108.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$108.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$108.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.08
|
| Rate for Payer: SOMOS Essential |
$81.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$108.11
|
|
|
PR TEMPORARY TRANSCUTANEOUS PACING
|
Professional
|
Both
|
$5.43
|
|
|
Service Code
|
HCPCS 92953
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$5.73 |
| Rate for Payer: Amida Care Medicaid |
$5.73
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.01
|
| Rate for Payer: Healthfirst Commercial |
$1.35
|
| Rate for Payer: Healthfirst Essential Plan |
$3.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.28
|
| Rate for Payer: Healthfirst QHP |
$1.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.01
|
| Rate for Payer: SOMOS Essential |
$1.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.35
|
|
|
PR TENDON GRAFT FROM A DISTANCE
|
Professional
|
Both
|
$2,215.68
|
|
|
Service Code
|
HCPCS 20924
|
| Min. Negotiated Rate |
$419.99 |
| Max. Negotiated Rate |
$1,349.98 |
| Rate for Payer: Cash Price |
$601.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$599.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$539.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$539.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$569.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$599.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$569.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$599.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$599.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$449.99
|
| Rate for Payer: Healthfirst Commercial |
$599.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,349.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.99
|
| Rate for Payer: Healthfirst QHP |
$599.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$419.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$599.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$509.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$419.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$599.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$449.99
|
| Rate for Payer: SOMOS Essential |
$449.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$599.99
|
|
|
PR TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON
|
Professional
|
Both
|
$2,559.34
|
|
|
Service Code
|
HCPCS 24305
|
| Min. Negotiated Rate |
$486.09 |
| Max. Negotiated Rate |
$1,562.44 |
| Rate for Payer: Cash Price |
$696.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$694.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$624.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$624.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$659.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$694.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$659.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$694.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$694.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$520.82
|
| Rate for Payer: Healthfirst Commercial |
$694.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,562.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$659.70
|
| Rate for Payer: Healthfirst QHP |
$694.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$486.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$694.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$590.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$486.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$694.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$520.82
|
| Rate for Payer: SOMOS Essential |
$520.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$694.42
|
|
|
PR TENDON SHEATH INCISION
|
Professional
|
Both
|
$1,291.40
|
|
|
Service Code
|
HCPCS 26055
|
| Min. Negotiated Rate |
$247.41 |
| Max. Negotiated Rate |
$795.24 |
| Rate for Payer: Cash Price |
$352.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$353.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$318.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$318.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$335.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$353.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$335.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$353.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$353.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$265.08
|
| Rate for Payer: Healthfirst Commercial |
$353.44
|
| Rate for Payer: Healthfirst Essential Plan |
$795.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$335.77
|
| Rate for Payer: Healthfirst QHP |
$353.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$247.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$353.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$300.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$247.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$353.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$265.08
|
| Rate for Payer: SOMOS Essential |
$265.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$353.44
|
|
|
PR TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT
|
Professional
|
Both
|
$3,850.74
|
|
|
Service Code
|
HCPCS 26483
|
| Min. Negotiated Rate |
$714.93 |
| Max. Negotiated Rate |
$2,297.99 |
| Rate for Payer: Cash Price |
$1,039.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,021.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$919.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$919.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$970.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,021.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$970.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,021.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,021.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$766.00
|
| Rate for Payer: Healthfirst Commercial |
$1,021.33
|
| Rate for Payer: Healthfirst Essential Plan |
$2,297.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$970.26
|
| Rate for Payer: Healthfirst QHP |
$1,021.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$714.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,021.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$868.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$714.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,021.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$766.00
|
| Rate for Payer: SOMOS Essential |
$766.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,021.33
|
|
|
PR TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,646.42
|
|
|
Service Code
|
HCPCS 24340
|
| Min. Negotiated Rate |
$507.43 |
| Max. Negotiated Rate |
$1,631.03 |
| Rate for Payer: Cash Price |
$714.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$724.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$652.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$652.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$688.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$724.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$688.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$724.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$724.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$543.67
|
| Rate for Payer: Healthfirst Commercial |
$724.90
|
| Rate for Payer: Healthfirst Essential Plan |
$1,631.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$688.65
|
| Rate for Payer: Healthfirst QHP |
$724.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$507.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$724.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$616.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$507.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$724.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$543.67
|
| Rate for Payer: SOMOS Essential |
$543.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$724.90
|
|
|
PR TENODESIS DISTAL JOINT EACH
|
Professional
|
Both
|
$2,904.51
|
|
|
Service Code
|
HCPCS 26474
|
| Min. Negotiated Rate |
$537.77 |
| Max. Negotiated Rate |
$1,728.54 |
| Rate for Payer: Cash Price |
$783.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$768.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$691.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$729.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$768.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$729.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$768.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$768.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$576.18
|
| Rate for Payer: Healthfirst Commercial |
$768.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,728.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$729.83
|
| Rate for Payer: Healthfirst QHP |
$768.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$537.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$768.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$653.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$537.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$768.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$576.18
|
| Rate for Payer: SOMOS Essential |
$576.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$768.24
|
|
|
PR TENODESIS LONG TENDON BICEPS
|
Professional
|
Both
|
$3,290.67
|
|
|
Service Code
|
HCPCS 23430
|
| Min. Negotiated Rate |
$620.02 |
| Max. Negotiated Rate |
$1,992.91 |
| Rate for Payer: Cash Price |
$891.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$885.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$797.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$797.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$841.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$885.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$841.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$885.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$885.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$664.30
|
| Rate for Payer: Healthfirst Commercial |
$885.74
|
| Rate for Payer: Healthfirst Essential Plan |
$1,992.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$841.45
|
| Rate for Payer: Healthfirst QHP |
$885.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$620.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$885.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$752.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$620.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$885.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$664.30
|
| Rate for Payer: SOMOS Essential |
$664.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$885.74
|
|
