|
PR ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT
|
Professional
|
Both
|
$2,867.52
|
|
|
Service Code
|
HCPCS 27332
|
| Min. Negotiated Rate |
$542.97 |
| Max. Negotiated Rate |
$1,745.26 |
| Rate for Payer: Cash Price |
$777.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$775.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$698.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$698.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$736.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$775.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$736.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$775.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$775.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$581.75
|
| Rate for Payer: Healthfirst Commercial |
$775.67
|
| Rate for Payer: Healthfirst Essential Plan |
$1,745.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$736.89
|
| Rate for Payer: Healthfirst QHP |
$775.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$542.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$775.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$659.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$542.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$775.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$581.75
|
| Rate for Payer: SOMOS Essential |
$581.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$775.67
|
|
|
PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT
|
Professional
|
Both
|
$1,287.37
|
|
|
Service Code
|
HCPCS 28024
|
| Min. Negotiated Rate |
$252.47 |
| Max. Negotiated Rate |
$811.51 |
| Rate for Payer: Cash Price |
$358.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$324.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$342.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$342.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$360.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$270.50
|
| Rate for Payer: Healthfirst Commercial |
$360.67
|
| Rate for Payer: Healthfirst Essential Plan |
$811.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$342.64
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$252.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$360.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$306.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$252.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$270.50
|
| Rate for Payer: SOMOS Essential |
$270.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
|
|
PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT
|
Professional
|
Both
|
$1,382.82
|
|
|
Service Code
|
HCPCS 28022
|
| Min. Negotiated Rate |
$265.65 |
| Max. Negotiated Rate |
$853.88 |
| Rate for Payer: Cash Price |
$381.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$379.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$341.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$341.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$360.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$379.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$360.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$379.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$379.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$284.62
|
| Rate for Payer: Healthfirst Commercial |
$379.50
|
| Rate for Payer: Healthfirst Essential Plan |
$853.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$360.52
|
| Rate for Payer: Healthfirst QHP |
$379.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$265.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$379.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$322.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$265.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$379.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$284.62
|
| Rate for Payer: SOMOS Essential |
$284.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$379.50
|
|
|
PR ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT
|
Professional
|
Both
|
$1,581.34
|
|
|
Service Code
|
HCPCS 28020
|
| Min. Negotiated Rate |
$295.88 |
| Max. Negotiated Rate |
$951.03 |
| Rate for Payer: Cash Price |
$428.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$422.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$380.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$380.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$401.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$422.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$401.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$422.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$317.01
|
| Rate for Payer: Healthfirst Commercial |
$422.68
|
| Rate for Payer: Healthfirst Essential Plan |
$951.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$401.55
|
| Rate for Payer: Healthfirst QHP |
$422.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$295.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$422.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$359.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$295.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$422.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$317.01
|
| Rate for Payer: SOMOS Essential |
$317.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$422.68
|
|
|
PR ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB
|
Professional
|
Both
|
$1,796.94
|
|
|
Service Code
|
HCPCS 25101
|
| Min. Negotiated Rate |
$343.06 |
| Max. Negotiated Rate |
$1,102.68 |
| Rate for Payer: Cash Price |
$491.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$490.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$441.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$441.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$465.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$490.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$465.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$490.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$490.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$367.56
|
| Rate for Payer: Healthfirst Commercial |
$490.08
|
| Rate for Payer: Healthfirst Essential Plan |
$1,102.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$465.58
|
| Rate for Payer: Healthfirst QHP |
$490.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$343.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$490.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$416.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$343.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$490.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$367.56
|
| Rate for Payer: SOMOS Essential |
$367.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$490.08
|
|
|
PR ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA
|
Professional
|
Both
|
$3,393.85
|
|
|
Service Code
|
HCPCS 27335
|
| Min. Negotiated Rate |
$640.45 |
| Max. Negotiated Rate |
$2,058.59 |
| Rate for Payer: Cash Price |
$919.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$914.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$823.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$823.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$869.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$914.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$869.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$914.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$914.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$686.20
|
| Rate for Payer: Healthfirst Commercial |
$914.93
|
| Rate for Payer: Healthfirst Essential Plan |
$2,058.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$869.18
|
| Rate for Payer: Healthfirst QHP |
$914.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$640.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$914.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$777.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$640.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$914.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$686.20
|
| Rate for Payer: SOMOS Essential |
$686.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$914.93
|
|
|
PR ARTIFICIAL INSEMINATION INTRA-CERVICAL
|
Professional
|
Both
|
$213.50
|
|
|
Service Code
|
HCPCS 58321
|
| Min. Negotiated Rate |
$38.89 |
| Max. Negotiated Rate |
$125.01 |
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.67
|
| Rate for Payer: Healthfirst Commercial |
$55.56
|
| Rate for Payer: Healthfirst Essential Plan |
$125.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.78
|
| Rate for Payer: Healthfirst QHP |
$55.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.67
|
| Rate for Payer: SOMOS Essential |
$41.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.56
|
|
|
PR ARTIFICIAL INSEMINATION INTRA-UTERINE
|
Professional
|
Both
|
$251.58
|
|
|
Service Code
|
HCPCS 58322
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$147.85 |
| Rate for Payer: Cash Price |
$67.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.28
|
| Rate for Payer: Healthfirst Commercial |
$65.71
|
| Rate for Payer: Healthfirst Essential Plan |
$147.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.42
|
| Rate for Payer: Healthfirst QHP |
$65.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.28
|
| Rate for Payer: SOMOS Essential |
$49.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.71
|
|
|
PR ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX CUTDOWN
|
Professional
|
Both
|
$453.46
|
|
|
Service Code
|
HCPCS 36625
|
| Min. Negotiated Rate |
$82.61 |
| Max. Negotiated Rate |
$265.52 |
| Rate for Payer: Cash Price |
$120.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.51
|
| Rate for Payer: Healthfirst Commercial |
$118.01
|
| Rate for Payer: Healthfirst Essential Plan |
$265.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.11
|
| Rate for Payer: Healthfirst QHP |
$118.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.51
|
| Rate for Payer: SOMOS Essential |
$88.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.01
|
|
|
PR ARTL CATHJ/CANNULJ MNTR/TRANSFUSION SPX PRQ
|
Professional
|
Both
|
$182.81
|
|
|
Service Code
|
HCPCS 36620
|
| Min. Negotiated Rate |
$33.28 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Cash Price |
$48.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.66
|
| Rate for Payer: Healthfirst Commercial |
$47.55
|
| Rate for Payer: Healthfirst Essential Plan |
$106.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.17
|
| Rate for Payer: Healthfirst QHP |
$47.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.66
|
| Rate for Payer: SOMOS Essential |
$35.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.55
|
|
|
PR ARTL CATHJ PROLNG NFS THER CHEMOTX CUTDOWN
|
Professional
|
Both
|
$477.72
|
|
|
Service Code
|
HCPCS 36640
|
| Min. Negotiated Rate |
$90.99 |
| Max. Negotiated Rate |
$292.45 |
| Rate for Payer: Cash Price |
$131.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.48
|
| Rate for Payer: Healthfirst Commercial |
$129.98
|
| Rate for Payer: Healthfirst Essential Plan |
$292.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$123.48
|
| Rate for Payer: Healthfirst QHP |
$129.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$129.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.48
|
| Rate for Payer: SOMOS Essential |
$97.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.98
|
|
|
PR ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE
|
Professional
|
Both
|
$67.03
|
|
|
Service Code
|
HCPCS 93050
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: Amida Care Medicaid |
$11.36
|
| Rate for Payer: Cash Price |
$18.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.05
|
| Rate for Payer: Healthfirst Commercial |
$18.74
|
| Rate for Payer: Healthfirst Essential Plan |
$42.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.80
|
| Rate for Payer: Healthfirst QHP |
$18.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.05
|
| Rate for Payer: SOMOS Essential |
$14.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.74
|
|
|
PR ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE
|
Professional
|
Both
|
$32.66
|
|
|
Service Code
|
HCPCS 93050 26
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Amida Care Medicaid |
$11.36
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.60
|
| Rate for Payer: Healthfirst Commercial |
$8.80
|
| Rate for Payer: Healthfirst Essential Plan |
$19.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.36
|
| Rate for Payer: Healthfirst QHP |
$8.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.60
|
| Rate for Payer: SOMOS Essential |
$6.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.80
|
|
|
PR ART PRESS WAVEFORM ANALYS CENTRAL ART PRESSURE
|
Professional
|
Both
|
$34.37
|
|
|
Service Code
|
HCPCS 93050 TC
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$22.34 |
| Rate for Payer: Amida Care Medicaid |
$11.36
|
| Rate for Payer: Cash Price |
$9.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.45
|
| Rate for Payer: Healthfirst Commercial |
$9.93
|
| Rate for Payer: Healthfirst Essential Plan |
$22.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.43
|
| Rate for Payer: Healthfirst QHP |
$9.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.45
|
| Rate for Payer: SOMOS Essential |
$7.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.93
|
|
|
PR ARVEN ANAST OPN F/ARM VEIN TRPOS
|
Professional
|
Both
|
$3,206.70
|
|
|
Service Code
|
HCPCS 36820
|
| Min. Negotiated Rate |
$594.93 |
| Max. Negotiated Rate |
$1,912.28 |
| Rate for Payer: Cash Price |
$855.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$849.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$764.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$764.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$807.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$849.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$807.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$849.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$849.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$637.42
|
| Rate for Payer: Healthfirst Commercial |
$849.90
|
| Rate for Payer: Healthfirst Essential Plan |
$1,912.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$807.40
|
| Rate for Payer: Healthfirst QHP |
$849.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$594.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$849.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$722.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$594.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$849.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$637.42
|
| Rate for Payer: SOMOS Essential |
$637.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$849.90
|
|
|
PR ARVEN ANAST OPN UPR ARM BASILIC VEIN TRPOS
|
Professional
|
Both
|
$3,244.22
|
|
|
Service Code
|
HCPCS 36819
|
| Min. Negotiated Rate |
$593.97 |
| Max. Negotiated Rate |
$1,909.19 |
| Rate for Payer: Cash Price |
$861.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$848.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$763.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$763.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$806.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$848.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$806.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$848.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$848.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$636.40
|
| Rate for Payer: Healthfirst Commercial |
$848.53
|
| Rate for Payer: Healthfirst Essential Plan |
$1,909.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$806.10
|
| Rate for Payer: Healthfirst QHP |
$848.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$593.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$848.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$721.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$593.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$848.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$636.40
|
| Rate for Payer: SOMOS Essential |
$636.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$848.53
|
|
|
PR ARVEN ANAST OPN UPR ARM CEPHALIC VEIN TRPOS
|
Professional
|
Both
|
$3,061.38
|
|
|
Service Code
|
HCPCS 36818
|
| Min. Negotiated Rate |
$561.34 |
| Max. Negotiated Rate |
$1,804.32 |
| Rate for Payer: Cash Price |
$812.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$801.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$721.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$721.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$761.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$801.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$761.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$801.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$801.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$601.44
|
| Rate for Payer: Healthfirst Commercial |
$801.92
|
| Rate for Payer: Healthfirst Essential Plan |
$1,804.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$761.82
|
| Rate for Payer: Healthfirst QHP |
$801.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$561.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$801.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$681.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$561.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$801.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$601.44
|
| Rate for Payer: SOMOS Essential |
$601.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$801.92
|
|
|
PR ARYSM VASC MALFRMJ/CRTD-OCCLUSION CRTD ART
|
Professional
|
Both
|
$12,570.53
|
|
|
Service Code
|
HCPCS 61705
|
| Min. Negotiated Rate |
$2,292.97 |
| Max. Negotiated Rate |
$7,370.26 |
| Rate for Payer: Cash Price |
$3,306.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,275.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,948.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,948.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,111.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,275.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,111.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,275.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,275.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,456.75
|
| Rate for Payer: Healthfirst Commercial |
$3,275.67
|
| Rate for Payer: Healthfirst Essential Plan |
$7,370.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,111.89
|
| Rate for Payer: Healthfirst QHP |
$3,275.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,292.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,275.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,784.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,292.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,275.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,456.75
|
| Rate for Payer: SOMOS Essential |
$2,456.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,275.67
|
|
|
PR ARYSM VASC MALFRMJ IA EMBOLIZATION
|
Professional
|
Both
|
$10,371.45
|
|
|
Service Code
|
HCPCS 61710
|
| Min. Negotiated Rate |
$1,893.21 |
| Max. Negotiated Rate |
$6,085.31 |
| Rate for Payer: Cash Price |
$2,729.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,704.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,434.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,434.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,569.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,704.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,569.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,704.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,704.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,028.43
|
| Rate for Payer: Healthfirst Commercial |
$2,704.58
|
| Rate for Payer: Healthfirst Essential Plan |
$6,085.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,569.35
|
| Rate for Payer: Healthfirst QHP |
$2,704.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,893.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,704.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,298.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,893.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,704.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,028.43
|
| Rate for Payer: SOMOS Essential |
$2,028.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,704.58
|
|
|
PR ARYSM VASC MALFRMJ/ICRA ELECTROTHROMBOSIS
|
Professional
|
Both
|
$12,293.33
|
|
|
Service Code
|
HCPCS 61708
|
| Min. Negotiated Rate |
$2,243.30 |
| Max. Negotiated Rate |
$7,210.60 |
| Rate for Payer: Cash Price |
$3,236.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,204.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,884.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,884.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,044.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,204.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,044.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,204.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,204.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,403.53
|
| Rate for Payer: Healthfirst Commercial |
$3,204.71
|
| Rate for Payer: Healthfirst Essential Plan |
$7,210.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,044.47
|
| Rate for Payer: Healthfirst QHP |
$3,204.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,243.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,204.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,724.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,243.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,204.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,403.53
|
| Rate for Payer: SOMOS Essential |
$2,403.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,204.71
|
|
|
PR ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH
|
Professional
|
Both
|
$4,389.63
|
|
|
Service Code
|
HCPCS 31400
|
| Min. Negotiated Rate |
$823.56 |
| Max. Negotiated Rate |
$2,647.17 |
| Rate for Payer: Cash Price |
$1,186.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,176.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,058.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,058.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,117.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,176.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,117.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,176.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,176.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$882.39
|
| Rate for Payer: Healthfirst Commercial |
$1,176.52
|
| Rate for Payer: Healthfirst Essential Plan |
$2,647.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,117.69
|
| Rate for Payer: Healthfirst QHP |
$1,176.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$823.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,176.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,000.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$823.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,176.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$882.39
|
| Rate for Payer: SOMOS Essential |
$882.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,176.52
|
|
|
PR AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT
|
Professional
|
Both
|
$13,909.56
|
|
|
Service Code
|
HCPCS 33863
|
| Min. Negotiated Rate |
$2,556.74 |
| Max. Negotiated Rate |
$8,218.08 |
| Rate for Payer: Cash Price |
$3,689.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,652.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,287.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,287.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,469.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,652.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,469.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,652.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,652.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,739.36
|
| Rate for Payer: Healthfirst Commercial |
$3,652.48
|
| Rate for Payer: Healthfirst Essential Plan |
$8,218.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,469.86
|
| Rate for Payer: Healthfirst QHP |
$3,652.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,556.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,652.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,104.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,556.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,652.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,739.36
|
| Rate for Payer: SOMOS Essential |
$2,739.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,652.48
|
|
|
PR AS-AORT GRF W/CARD BYP F/AORTIC DISSECTION
|
Professional
|
Both
|
$15,016.61
|
|
|
Service Code
|
HCPCS 33858
|
| Min. Negotiated Rate |
$2,760.53 |
| Max. Negotiated Rate |
$8,873.15 |
| Rate for Payer: Cash Price |
$3,981.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,943.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,549.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,549.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,746.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,943.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,746.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,943.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,943.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,957.72
|
| Rate for Payer: Healthfirst Commercial |
$3,943.62
|
| Rate for Payer: Healthfirst Essential Plan |
$8,873.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,746.44
|
| Rate for Payer: Healthfirst QHP |
$3,943.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,760.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,943.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,352.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,760.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,943.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,957.72
|
| Rate for Payer: SOMOS Essential |
$2,957.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,943.62
|
|
|
PR AS-AORT GRF W/CARD BYP F/AORTIC DS OTH/THN DSJ
|
Professional
|
Both
|
$10,775.52
|
|
|
Service Code
|
HCPCS 33859
|
| Min. Negotiated Rate |
$1,983.83 |
| Max. Negotiated Rate |
$6,376.59 |
| Rate for Payer: Cash Price |
$2,861.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,834.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,550.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,550.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,692.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,834.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,692.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,834.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,834.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,125.53
|
| Rate for Payer: Healthfirst Commercial |
$2,834.04
|
| Rate for Payer: Healthfirst Essential Plan |
$6,376.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,692.34
|
| Rate for Payer: Healthfirst QHP |
$2,834.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,983.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,834.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,408.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,983.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,834.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,125.53
|
| Rate for Payer: SOMOS Essential |
$2,125.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,834.04
|
|
|
PR ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL
|
Professional
|
Both
|
$14,225.68
|
|
|
Service Code
|
HCPCS 33864
|
| Min. Negotiated Rate |
$2,614.77 |
| Max. Negotiated Rate |
$8,404.63 |
| Rate for Payer: Cash Price |
$3,770.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,735.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,361.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,361.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,548.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,735.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,548.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,735.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,735.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,801.54
|
| Rate for Payer: Healthfirst Commercial |
$3,735.39
|
| Rate for Payer: Healthfirst Essential Plan |
$8,404.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,548.62
|
| Rate for Payer: Healthfirst QHP |
$3,735.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,614.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,735.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,175.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,614.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,735.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,801.54
|
| Rate for Payer: SOMOS Essential |
$2,801.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,735.39
|
|
