|
PR BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS
|
Professional
|
Both
|
$442.61
|
|
|
Service Code
|
HCPCS 44100
|
| Min. Negotiated Rate |
$82.87 |
| Max. Negotiated Rate |
$266.38 |
| Rate for Payer: Cash Price |
$120.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.79
|
| Rate for Payer: Healthfirst Commercial |
$118.39
|
| Rate for Payer: Healthfirst Essential Plan |
$266.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.47
|
| Rate for Payer: Healthfirst QHP |
$118.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.79
|
| Rate for Payer: SOMOS Essential |
$88.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.39
|
|
|
PR BX LVR NDL DONE PURPOSE TM OTH MAJOR PX
|
Professional
|
Both
|
$465.89
|
|
|
Service Code
|
HCPCS 47001
|
| Min. Negotiated Rate |
$86.58 |
| Max. Negotiated Rate |
$278.30 |
| Rate for Payer: Cash Price |
$123.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.77
|
| Rate for Payer: Healthfirst Commercial |
$123.69
|
| Rate for Payer: Healthfirst Essential Plan |
$278.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.51
|
| Rate for Payer: Healthfirst QHP |
$123.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.77
|
| Rate for Payer: SOMOS Essential |
$92.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.69
|
|
|
PR BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION
|
Professional
|
Both
|
$610.65
|
|
|
Service Code
|
HCPCS 42806
|
| Min. Negotiated Rate |
$115.56 |
| Max. Negotiated Rate |
$371.43 |
| Rate for Payer: Cash Price |
$167.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$156.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$156.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.81
|
| Rate for Payer: Healthfirst Commercial |
$165.08
|
| Rate for Payer: Healthfirst Essential Plan |
$371.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.83
|
| Rate for Payer: Healthfirst QHP |
$165.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.81
|
| Rate for Payer: SOMOS Essential |
$123.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.08
|
|
|
PR BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID
|
Professional
|
Both
|
$1,577.10
|
|
|
Service Code
|
HCPCS 55706
|
| Min. Negotiated Rate |
$301.70 |
| Max. Negotiated Rate |
$969.75 |
| Rate for Payer: Cash Price |
$432.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$431.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$387.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$387.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$409.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$431.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$409.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$431.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$431.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$323.25
|
| Rate for Payer: Healthfirst Commercial |
$431.00
|
| Rate for Payer: Healthfirst Essential Plan |
$969.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$409.45
|
| Rate for Payer: Healthfirst QHP |
$431.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$301.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$431.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$366.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$301.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$431.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$323.25
|
| Rate for Payer: SOMOS Essential |
$323.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$431.00
|
|
|
PR BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN
|
Professional
|
Both
|
$353.26
|
|
|
Service Code
|
HCPCS 35681
|
| Min. Negotiated Rate |
$64.43 |
| Max. Negotiated Rate |
$207.09 |
| Rate for Payer: Cash Price |
$93.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.03
|
| Rate for Payer: Healthfirst Commercial |
$92.04
|
| Rate for Payer: Healthfirst Essential Plan |
$207.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.44
|
| Rate for Payer: Healthfirst QHP |
$92.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.03
|
| Rate for Payer: SOMOS Essential |
$69.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.04
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC
|
Professional
|
Both
|
$8,033.45
|
|
|
Service Code
|
HCPCS 35632
|
| Min. Negotiated Rate |
$1,472.20 |
| Max. Negotiated Rate |
$4,732.06 |
| Rate for Payer: Cash Price |
$2,127.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,103.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,892.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,892.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,997.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,103.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,997.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,103.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,103.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,577.36
|
| Rate for Payer: Healthfirst Commercial |
$2,103.14
|
| Rate for Payer: Healthfirst Essential Plan |
$4,732.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,997.98
|
| Rate for Payer: Healthfirst QHP |
$2,103.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,472.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,103.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,787.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,472.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,103.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,577.36
|
| Rate for Payer: SOMOS Essential |
$1,577.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,103.14
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC
|
Professional
|
Both
|
$8,820.04
|
|
|
Service Code
|
HCPCS 35633
|
| Min. Negotiated Rate |
$1,607.83 |
| Max. Negotiated Rate |
$5,168.02 |
| Rate for Payer: Cash Price |
$2,333.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,296.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,067.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,067.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,182.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,296.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,182.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,296.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,296.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,722.67
|
| Rate for Payer: Healthfirst Commercial |
$2,296.90
|
| Rate for Payer: Healthfirst Essential Plan |
$5,168.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,182.05
|
| Rate for Payer: Healthfirst QHP |
$2,296.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,607.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,296.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,952.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,607.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,296.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,722.67
|
| Rate for Payer: SOMOS Essential |
$1,722.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,296.90
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL
|
Professional
|
Both
|
$7,864.01
|
|
|
Service Code
|
HCPCS 35634
|
| Min. Negotiated Rate |
$1,440.73 |
| Max. Negotiated Rate |
$4,630.90 |
| Rate for Payer: Cash Price |
$2,082.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,058.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,852.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,852.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,955.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,058.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,955.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,058.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,058.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,543.63
|
| Rate for Payer: Healthfirst Commercial |
$2,058.18
|
| Rate for Payer: Healthfirst Essential Plan |
$4,630.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,955.27
|
| Rate for Payer: Healthfirst QHP |
$2,058.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,440.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,058.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,749.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,440.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,058.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,543.63
|
| Rate for Payer: SOMOS Essential |
$1,543.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,058.18
|
|
|
PR BYPASS NOT VEIN AORTOSUBCLA/CAROTID/INNOMINATE
|
Professional
|
Both
|
$7,044.59
|
|
|
Service Code
|
HCPCS 35626
|
| Min. Negotiated Rate |
$1,299.41 |
| Max. Negotiated Rate |
$4,176.68 |
| Rate for Payer: Cash Price |
$1,864.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,856.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,670.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,670.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,763.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,856.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,763.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,856.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,856.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,392.22
|
| Rate for Payer: Healthfirst Commercial |
$1,856.30
|
| Rate for Payer: Healthfirst Essential Plan |
$4,176.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,763.48
|
| Rate for Payer: Healthfirst QHP |
$1,856.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,299.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,856.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,577.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,299.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,856.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,392.22
|
| Rate for Payer: SOMOS Essential |
$1,392.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,856.30
|
|
|
PR BYPASS W/VEIN AORTOBIFEMORAL
|
Professional
|
Both
|
$10,868.34
|
|
|
Service Code
|
HCPCS 35540
|
| Min. Negotiated Rate |
$1,989.44 |
| Max. Negotiated Rate |
$6,394.64 |
| Rate for Payer: Cash Price |
$2,875.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,842.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,557.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,557.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,699.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,842.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,699.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,842.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,842.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,131.55
|
| Rate for Payer: Healthfirst Commercial |
$2,842.06
|
| Rate for Payer: Healthfirst Essential Plan |
$6,394.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,699.96
|
| Rate for Payer: Healthfirst QHP |
$2,842.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,989.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,842.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,415.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,989.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,842.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,131.55
|
| Rate for Payer: SOMOS Essential |
$2,131.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,842.06
|
|
|
PR BYPASS W/VEIN AORTOBI-ILIAC
|
Professional
|
Both
|
$10,389.65
|
|
|
Service Code
|
HCPCS 35538
|
| Min. Negotiated Rate |
$1,902.68 |
| Max. Negotiated Rate |
$6,115.77 |
| Rate for Payer: Cash Price |
$2,749.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,718.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,446.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,446.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,582.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,718.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,582.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,718.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,718.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,038.59
|
| Rate for Payer: Healthfirst Commercial |
$2,718.12
|
| Rate for Payer: Healthfirst Essential Plan |
$6,115.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,582.21
|
| Rate for Payer: Healthfirst QHP |
$2,718.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,902.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,718.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,310.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,902.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,718.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,038.59
|
| Rate for Payer: SOMOS Essential |
$2,038.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,718.12
|
|
|
PR BYPASS W/VEIN AORTOCELIAC/AORTOMESENTERIC
|
Professional
|
Both
|
$8,678.01
|
|
|
Service Code
|
HCPCS 35531
|
| Min. Negotiated Rate |
$1,589.01 |
| Max. Negotiated Rate |
$5,107.55 |
| Rate for Payer: Cash Price |
$2,297.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,270.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,043.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,043.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,156.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,270.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,156.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,270.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,270.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,702.52
|
| Rate for Payer: Healthfirst Commercial |
$2,270.02
|
| Rate for Payer: Healthfirst Essential Plan |
$5,107.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,156.52
|
| Rate for Payer: Healthfirst QHP |
$2,270.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,589.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,270.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,929.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,589.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,270.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,702.52
|
| Rate for Payer: SOMOS Essential |
$1,702.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,270.02
|
|
|
PR BYPASS W/VEIN AORTOFEMORAL
|
Professional
|
Both
|
$9,747.75
|
|
|
Service Code
|
HCPCS 35539
|
| Min. Negotiated Rate |
$1,785.20 |
| Max. Negotiated Rate |
$5,738.13 |
| Rate for Payer: Cash Price |
$2,580.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,550.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,295.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,295.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,422.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,550.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,422.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,550.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,550.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,912.71
|
| Rate for Payer: Healthfirst Commercial |
$2,550.28
|
| Rate for Payer: Healthfirst Essential Plan |
$5,738.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,422.77
|
| Rate for Payer: Healthfirst QHP |
$2,550.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,785.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,550.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,167.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,785.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,550.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,912.71
|
| Rate for Payer: SOMOS Essential |
$1,912.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,550.28
|
|
|
PR BYPASS W/VEIN AORTOILIAC
|
Professional
|
Both
|
$9,268.91
|
|
|
Service Code
|
HCPCS 35537
|
| Min. Negotiated Rate |
$1,697.84 |
| Max. Negotiated Rate |
$5,457.35 |
| Rate for Payer: Cash Price |
$2,455.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,425.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,182.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,182.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,304.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,425.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,304.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,425.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,425.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,819.12
|
| Rate for Payer: Healthfirst Commercial |
$2,425.49
|
| Rate for Payer: Healthfirst Essential Plan |
$5,457.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,304.22
|
| Rate for Payer: Healthfirst QHP |
$2,425.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,697.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,425.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,061.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,697.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,425.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,819.12
|
| Rate for Payer: SOMOS Essential |
$1,819.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,425.49
|
|
|
PR BYPASS W/VEIN AORTORENAL
|
Professional
|
Both
|
$7,581.98
|
|
|
Service Code
|
HCPCS 35560
|
| Min. Negotiated Rate |
$1,389.98 |
| Max. Negotiated Rate |
$4,467.80 |
| Rate for Payer: Cash Price |
$2,008.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,985.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,787.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,787.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,886.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,985.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,886.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,985.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,985.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,489.27
|
| Rate for Payer: Healthfirst Commercial |
$1,985.69
|
| Rate for Payer: Healthfirst Essential Plan |
$4,467.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,886.41
|
| Rate for Payer: Healthfirst QHP |
$1,985.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,389.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,985.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,687.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,389.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,985.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,489.27
|
| Rate for Payer: SOMOS Essential |
$1,489.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,985.69
|
|
|
PR BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE
|
Professional
|
Both
|
$7,617.82
|
|
|
Service Code
|
HCPCS 35526
|
| Min. Negotiated Rate |
$1,403.02 |
| Max. Negotiated Rate |
$4,509.72 |
| Rate for Payer: Cash Price |
$2,023.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,004.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,803.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,803.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,904.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,004.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,904.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,004.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,004.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,503.24
|
| Rate for Payer: Healthfirst Commercial |
$2,004.32
|
| Rate for Payer: Healthfirst Essential Plan |
$4,509.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,904.10
|
| Rate for Payer: Healthfirst QHP |
$2,004.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,403.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,004.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,703.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,403.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,004.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,503.24
|
| Rate for Payer: SOMOS Essential |
$1,503.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,004.32
|
|
|
PR BYPASS W/VEIN AXILLARY-AXILLARY
|
Professional
|
Both
|
$5,083.51
|
|
|
Service Code
|
HCPCS 35518
|
| Min. Negotiated Rate |
$933.21 |
| Max. Negotiated Rate |
$2,999.61 |
| Rate for Payer: Cash Price |
$1,345.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,333.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,199.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,199.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,266.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,333.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,266.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,333.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,333.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$999.87
|
| Rate for Payer: Healthfirst Commercial |
$1,333.16
|
| Rate for Payer: Healthfirst Essential Plan |
$2,999.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,266.50
|
| Rate for Payer: Healthfirst QHP |
$1,333.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$933.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,333.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,133.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$933.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,333.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$999.87
|
| Rate for Payer: SOMOS Essential |
$999.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,333.16
|
|
|
PR BYPASS W/VEIN AXILLARY-BRACHIAL
|
Professional
|
Both
|
$5,202.12
|
|
|
Service Code
|
HCPCS 35522
|
| Min. Negotiated Rate |
$954.32 |
| Max. Negotiated Rate |
$3,067.47 |
| Rate for Payer: Cash Price |
$1,377.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,363.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,226.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,295.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,363.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,295.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,363.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,363.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,022.49
|
| Rate for Payer: Healthfirst Commercial |
$1,363.32
|
| Rate for Payer: Healthfirst Essential Plan |
$3,067.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,295.15
|
| Rate for Payer: Healthfirst QHP |
$1,363.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$954.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,363.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,158.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$954.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,363.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,022.49
|
| Rate for Payer: SOMOS Essential |
$1,022.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,363.32
|
|
|
PR BYPASS W/VEIN AXILLARY-FEMORAL
|
Professional
|
Both
|
$5,463.85
|
|
|
Service Code
|
HCPCS 35521
|
| Min. Negotiated Rate |
$1,002.47 |
| Max. Negotiated Rate |
$3,222.22 |
| Rate for Payer: Cash Price |
$1,447.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,432.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,288.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,288.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,360.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,432.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,360.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,432.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,432.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,074.08
|
| Rate for Payer: Healthfirst Commercial |
$1,432.10
|
| Rate for Payer: Healthfirst Essential Plan |
$3,222.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,360.49
|
| Rate for Payer: Healthfirst QHP |
$1,432.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,002.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,432.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,217.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,002.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,432.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,074.08
|
| Rate for Payer: SOMOS Essential |
$1,074.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,432.10
|
|
|
PR BYPASS W/VEIN AXILLARY-FEMORAL-FEMORAL
|
Professional
|
Both
|
$6,705.65
|
|
|
Service Code
|
HCPCS 35533
|
| Min. Negotiated Rate |
$1,228.37 |
| Max. Negotiated Rate |
$3,948.34 |
| Rate for Payer: Cash Price |
$1,776.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,754.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,579.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,667.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,754.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,667.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,754.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,754.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,316.12
|
| Rate for Payer: Healthfirst Commercial |
$1,754.82
|
| Rate for Payer: Healthfirst Essential Plan |
$3,948.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,667.08
|
| Rate for Payer: Healthfirst QHP |
$1,754.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,228.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,754.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,491.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,228.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,754.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,316.12
|
| Rate for Payer: SOMOS Essential |
$1,316.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,754.82
|
|
|
PR BYPASS W/VEIN BRACHIAL-BRACHIAL
|
Professional
|
Both
|
$5,038.22
|
|
|
Service Code
|
HCPCS 35525
|
| Min. Negotiated Rate |
$898.16 |
| Max. Negotiated Rate |
$2,886.93 |
| Rate for Payer: Cash Price |
$1,332.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,283.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,154.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,154.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,218.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,283.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,218.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,283.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,283.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$962.31
|
| Rate for Payer: Healthfirst Commercial |
$1,283.08
|
| Rate for Payer: Healthfirst Essential Plan |
$2,886.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,218.93
|
| Rate for Payer: Healthfirst QHP |
$1,283.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$898.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,283.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,090.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$898.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,283.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$962.31
|
| Rate for Payer: SOMOS Essential |
$962.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,283.08
|
|
|
PR BYPASS W/VEIN BRACHIAL-ULNAR/-RADIAL
|
Professional
|
Both
|
$5,618.76
|
|
|
Service Code
|
HCPCS 35523
|
| Min. Negotiated Rate |
$1,003.83 |
| Max. Negotiated Rate |
$3,226.59 |
| Rate for Payer: Cash Price |
$1,449.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,434.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,290.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,290.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,362.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,434.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,362.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,434.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,434.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,075.53
|
| Rate for Payer: Healthfirst Commercial |
$1,434.04
|
| Rate for Payer: Healthfirst Essential Plan |
$3,226.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,362.34
|
| Rate for Payer: Healthfirst QHP |
$1,434.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,003.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,434.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,218.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,003.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,434.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,075.53
|
| Rate for Payer: SOMOS Essential |
$1,075.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,434.04
|
|
|
PR BYPASS W/VEIN CAROTID-BRACHIAL
|
Professional
|
Both
|
$5,470.99
|
|
|
Service Code
|
HCPCS 35510
|
| Min. Negotiated Rate |
$1,002.64 |
| Max. Negotiated Rate |
$3,222.79 |
| Rate for Payer: Cash Price |
$1,449.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,432.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,289.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,289.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,360.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,432.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,360.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,432.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,432.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,074.26
|
| Rate for Payer: Healthfirst Commercial |
$1,432.35
|
| Rate for Payer: Healthfirst Essential Plan |
$3,222.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,360.73
|
| Rate for Payer: Healthfirst QHP |
$1,432.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,002.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,432.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,217.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,002.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,432.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,074.26
|
| Rate for Payer: SOMOS Essential |
$1,074.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,432.35
|
|
|
PR BYPASS W/VEIN CAROTID-CONTRALATERAL CAROTID
|
Professional
|
Both
|
$6,277.25
|
|
|
Service Code
|
HCPCS 35509
|
| Min. Negotiated Rate |
$1,150.97 |
| Max. Negotiated Rate |
$3,699.54 |
| Rate for Payer: Cash Price |
$1,661.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,644.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,479.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,479.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,562.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,644.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,562.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,644.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,644.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,233.18
|
| Rate for Payer: Healthfirst Commercial |
$1,644.24
|
| Rate for Payer: Healthfirst Essential Plan |
$3,699.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,562.03
|
| Rate for Payer: Healthfirst QHP |
$1,644.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,150.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,644.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,397.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,150.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,644.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,233.18
|
| Rate for Payer: SOMOS Essential |
$1,233.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,644.24
|
|
|
PR BYPASS W/VEIN CAROTID-SUBCLV/SUBCLAVIAN CAROTID
|
Professional
|
Both
|
$5,667.62
|
|
|
Service Code
|
HCPCS 35506
|
| Min. Negotiated Rate |
$1,040.10 |
| Max. Negotiated Rate |
$3,343.16 |
| Rate for Payer: Cash Price |
$1,500.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,485.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,337.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,337.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,411.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,485.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,411.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,485.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,485.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,114.39
|
| Rate for Payer: Healthfirst Commercial |
$1,485.85
|
| Rate for Payer: Healthfirst Essential Plan |
$3,343.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,411.56
|
| Rate for Payer: Healthfirst QHP |
$1,485.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,040.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,485.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,262.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,040.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,485.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,114.39
|
| Rate for Payer: SOMOS Essential |
$1,114.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,485.85
|
|
