|
PR BYPASS W/VEIN CAROTID-VERTEBRAL
|
Professional
|
Both
|
$5,909.65
|
|
|
Service Code
|
HCPCS 35508
|
| Min. Negotiated Rate |
$1,085.77 |
| Max. Negotiated Rate |
$3,489.97 |
| Rate for Payer: Cash Price |
$1,566.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,551.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,395.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,395.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,473.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,551.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,473.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,551.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,551.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,163.33
|
| Rate for Payer: Healthfirst Commercial |
$1,551.10
|
| Rate for Payer: Healthfirst Essential Plan |
$3,489.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,473.55
|
| Rate for Payer: Healthfirst QHP |
$1,551.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,085.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,551.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,318.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,085.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,551.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,163.33
|
| Rate for Payer: SOMOS Essential |
$1,163.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,551.10
|
|
|
PR BYPASS W/VEIN COMMON-IPSILATERAL CAROTID
|
Professional
|
Both
|
$6,492.33
|
|
|
Service Code
|
HCPCS 35501
|
| Min. Negotiated Rate |
$1,189.00 |
| Max. Negotiated Rate |
$3,821.78 |
| Rate for Payer: Cash Price |
$1,719.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,698.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,528.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,528.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,613.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,698.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,613.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,698.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,698.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,273.93
|
| Rate for Payer: Healthfirst Commercial |
$1,698.57
|
| Rate for Payer: Healthfirst Essential Plan |
$3,821.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,613.64
|
| Rate for Payer: Healthfirst QHP |
$1,698.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,189.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,698.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,443.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,189.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,698.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,273.93
|
| Rate for Payer: SOMOS Essential |
$1,273.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,698.57
|
|
|
PR BYPASS W/VEIN FEMORAL-FEMORAL
|
Professional
|
Both
|
$5,478.20
|
|
|
Service Code
|
HCPCS 35558
|
| Min. Negotiated Rate |
$994.77 |
| Max. Negotiated Rate |
$3,197.47 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,421.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,278.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,278.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,350.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,421.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,350.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,421.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,421.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,065.83
|
| Rate for Payer: Healthfirst Commercial |
$1,421.10
|
| Rate for Payer: Healthfirst Essential Plan |
$3,197.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,350.05
|
| Rate for Payer: Healthfirst QHP |
$1,421.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$994.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,421.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,207.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$994.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,421.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,065.83
|
| Rate for Payer: SOMOS Essential |
$1,065.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,421.10
|
|
|
PR BYPASS W/VEIN FEMORAL-POPLITEAL
|
Professional
|
Both
|
$6,187.58
|
|
|
Service Code
|
HCPCS 35556
|
| Min. Negotiated Rate |
$1,133.40 |
| Max. Negotiated Rate |
$3,643.07 |
| Rate for Payer: Cash Price |
$1,637.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,619.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,457.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,457.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,538.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,619.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,538.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,619.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,619.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,214.36
|
| Rate for Payer: Healthfirst Commercial |
$1,619.14
|
| Rate for Payer: Healthfirst Essential Plan |
$3,643.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,538.18
|
| Rate for Payer: Healthfirst QHP |
$1,619.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,133.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,619.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,376.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,133.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,619.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,214.36
|
| Rate for Payer: SOMOS Essential |
$1,214.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,619.14
|
|
|
PR BYPASS W/VEIN HEPATORENAL
|
Professional
|
Both
|
$8,466.75
|
|
|
Service Code
|
HCPCS 35535
|
| Min. Negotiated Rate |
$1,550.76 |
| Max. Negotiated Rate |
$4,984.58 |
| Rate for Payer: Cash Price |
$2,241.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,215.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,993.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,993.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,104.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,215.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,104.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,215.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,215.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,661.53
|
| Rate for Payer: Healthfirst Commercial |
$2,215.37
|
| Rate for Payer: Healthfirst Essential Plan |
$4,984.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,104.60
|
| Rate for Payer: Healthfirst QHP |
$2,215.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,550.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,215.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,883.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,550.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,215.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,661.53
|
| Rate for Payer: SOMOS Essential |
$1,661.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,215.37
|
|
|
PR BYPASS W/VEIN ILIOFEMORAL
|
Professional
|
Both
|
$5,812.14
|
|
|
Service Code
|
HCPCS 35565
|
| Min. Negotiated Rate |
$1,065.88 |
| Max. Negotiated Rate |
$3,426.05 |
| Rate for Payer: Cash Price |
$1,542.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,522.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,370.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,370.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,446.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,522.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,446.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,522.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,522.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,142.02
|
| Rate for Payer: Healthfirst Commercial |
$1,522.69
|
| Rate for Payer: Healthfirst Essential Plan |
$3,426.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,446.56
|
| Rate for Payer: Healthfirst QHP |
$1,522.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,065.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,522.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,294.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,065.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,522.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,142.02
|
| Rate for Payer: SOMOS Essential |
$1,142.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,522.69
|
|
|
PR BYPASS W/VEIN ILIOILIAC
|
Professional
|
Both
|
$5,889.00
|
|
|
Service Code
|
HCPCS 35563
|
| Min. Negotiated Rate |
$1,080.79 |
| Max. Negotiated Rate |
$3,473.95 |
| Rate for Payer: Cash Price |
$1,560.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,543.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,389.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,389.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,466.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,543.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,466.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,543.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,543.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,157.98
|
| Rate for Payer: Healthfirst Commercial |
$1,543.98
|
| Rate for Payer: Healthfirst Essential Plan |
$3,473.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,466.78
|
| Rate for Payer: Healthfirst QHP |
$1,543.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,080.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,543.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,312.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,080.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,543.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,157.98
|
| Rate for Payer: SOMOS Essential |
$1,157.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,543.98
|
|
|
PR BYPASS W/VEIN SPLENORENAL
|
Professional
|
Both
|
$7,523.53
|
|
|
Service Code
|
HCPCS 35536
|
| Min. Negotiated Rate |
$1,377.93 |
| Max. Negotiated Rate |
$4,429.06 |
| Rate for Payer: Cash Price |
$1,990.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,968.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,771.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,771.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,870.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,968.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,870.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,968.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,968.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,476.35
|
| Rate for Payer: Healthfirst Commercial |
$1,968.47
|
| Rate for Payer: Healthfirst Essential Plan |
$4,429.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,870.05
|
| Rate for Payer: Healthfirst QHP |
$1,968.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,377.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,968.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,673.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,377.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,968.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,476.35
|
| Rate for Payer: SOMOS Essential |
$1,476.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,968.47
|
|
|
PR BYPASS W/VEIN SUBCLAVIAN-AXILLARY
|
Professional
|
Both
|
$5,427.59
|
|
|
Service Code
|
HCPCS 35516
|
| Min. Negotiated Rate |
$995.64 |
| Max. Negotiated Rate |
$3,200.29 |
| Rate for Payer: Cash Price |
$1,437.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,422.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,280.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,280.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,351.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,422.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,351.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,422.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,422.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,066.76
|
| Rate for Payer: Healthfirst Commercial |
$1,422.35
|
| Rate for Payer: Healthfirst Essential Plan |
$3,200.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,351.23
|
| Rate for Payer: Healthfirst QHP |
$1,422.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$995.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,422.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,209.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$995.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,422.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,066.76
|
| Rate for Payer: SOMOS Essential |
$1,066.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,422.35
|
|
|
PR BYPASS W/VEIN SUBCLAVIAN-BRACHIAL
|
Professional
|
Both
|
$5,358.57
|
|
|
Service Code
|
HCPCS 35512
|
| Min. Negotiated Rate |
$983.65 |
| Max. Negotiated Rate |
$3,161.74 |
| Rate for Payer: Cash Price |
$1,420.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,405.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,264.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,264.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,334.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,405.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,334.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,405.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,405.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,053.91
|
| Rate for Payer: Healthfirst Commercial |
$1,405.22
|
| Rate for Payer: Healthfirst Essential Plan |
$3,161.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,334.96
|
| Rate for Payer: Healthfirst QHP |
$1,405.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$983.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,405.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,194.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$983.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,405.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,053.91
|
| Rate for Payer: SOMOS Essential |
$1,053.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,405.22
|
|
|
PR BYPASS W/VEIN SUBCLAVIAN-SUBCLAVIAN
|
Professional
|
Both
|
$4,982.81
|
|
|
Service Code
|
HCPCS 35511
|
| Min. Negotiated Rate |
$914.13 |
| Max. Negotiated Rate |
$2,938.28 |
| Rate for Payer: Cash Price |
$1,320.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,305.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,175.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,175.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,240.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,305.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,240.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,305.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,305.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$979.42
|
| Rate for Payer: Healthfirst Commercial |
$1,305.90
|
| Rate for Payer: Healthfirst Essential Plan |
$2,938.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,240.61
|
| Rate for Payer: Healthfirst QHP |
$1,305.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$914.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,305.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,110.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$914.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,305.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$979.42
|
| Rate for Payer: SOMOS Essential |
$979.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,305.90
|
|
|
PR BYPASS W/VEIN SUBCLAVIAN-VERTEBRAL
|
Professional
|
Both
|
$5,909.65
|
|
|
Service Code
|
HCPCS 35515
|
| Min. Negotiated Rate |
$1,085.77 |
| Max. Negotiated Rate |
$3,489.97 |
| Rate for Payer: Cash Price |
$1,566.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,551.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,395.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,395.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,473.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,551.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,473.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,551.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,551.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,163.33
|
| Rate for Payer: Healthfirst Commercial |
$1,551.10
|
| Rate for Payer: Healthfirst Essential Plan |
$3,489.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,473.55
|
| Rate for Payer: Healthfirst QHP |
$1,551.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,085.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,551.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,318.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,085.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,551.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,163.33
|
| Rate for Payer: SOMOS Essential |
$1,163.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,551.10
|
|
|
PR BYP AUTOG COMPOSIT 2 SEG VEINS FROM 2 LOCATIONS
|
Professional
|
Both
|
$1,563.63
|
|
|
Service Code
|
HCPCS 35682
|
| Min. Negotiated Rate |
$285.89 |
| Max. Negotiated Rate |
$918.92 |
| Rate for Payer: Cash Price |
$413.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$408.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$367.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$367.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$387.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$408.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$387.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$408.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$408.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$306.31
|
| Rate for Payer: Healthfirst Commercial |
$408.41
|
| Rate for Payer: Healthfirst Essential Plan |
$918.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$387.99
|
| Rate for Payer: Healthfirst QHP |
$408.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$285.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$408.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$347.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$285.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$408.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$306.31
|
| Rate for Payer: SOMOS Essential |
$306.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$408.41
|
|
|
PR BYP AUTOG COMPOSIT 3/> SEG FROM 2/> LOCATION
|
Professional
|
Both
|
$1,822.38
|
|
|
Service Code
|
HCPCS 35683
|
| Min. Negotiated Rate |
$333.26 |
| Max. Negotiated Rate |
$1,071.18 |
| Rate for Payer: Cash Price |
$479.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$476.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$428.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$428.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$452.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$476.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$452.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$476.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$476.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$357.06
|
| Rate for Payer: Healthfirst Commercial |
$476.08
|
| Rate for Payer: Healthfirst Essential Plan |
$1,071.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$452.28
|
| Rate for Payer: Healthfirst QHP |
$476.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$333.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$476.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$404.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$333.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$476.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$357.06
|
| Rate for Payer: SOMOS Essential |
$357.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$476.08
|
|
|
PR BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL
|
Professional
|
Both
|
$7,383.29
|
|
|
Service Code
|
HCPCS 35566
|
| Min. Negotiated Rate |
$1,349.73 |
| Max. Negotiated Rate |
$4,338.40 |
| Rate for Payer: Cash Price |
$1,953.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,928.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,735.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,735.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,831.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,928.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,831.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,928.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,928.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,446.13
|
| Rate for Payer: Healthfirst Commercial |
$1,928.18
|
| Rate for Payer: Healthfirst Essential Plan |
$4,338.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,831.77
|
| Rate for Payer: Healthfirst QHP |
$1,928.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,349.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,928.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,638.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,349.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,928.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,446.13
|
| Rate for Payer: SOMOS Essential |
$1,446.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,928.18
|
|
|
PR BYP GRF W/DESCENDING THORACIC AORTA RPR NECK INC
|
Professional
|
Both
|
$4,284.81
|
|
|
Service Code
|
HCPCS 33891
|
| Min. Negotiated Rate |
$782.66 |
| Max. Negotiated Rate |
$2,515.70 |
| Rate for Payer: Cash Price |
$1,130.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,118.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,006.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,006.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,062.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,118.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,062.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,118.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,118.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$838.57
|
| Rate for Payer: Healthfirst Commercial |
$1,118.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,515.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,062.19
|
| Rate for Payer: Healthfirst QHP |
$1,118.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$782.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,118.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$950.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$782.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,118.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$838.57
|
| Rate for Payer: SOMOS Essential |
$838.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,118.09
|
|
|
PR BYP OTH/THN VEIN AORTOBIFEMORAL
|
Professional
|
Both
|
$7,573.69
|
|
|
Service Code
|
HCPCS 35646
|
| Min. Negotiated Rate |
$1,383.10 |
| Max. Negotiated Rate |
$4,445.69 |
| Rate for Payer: Cash Price |
$2,004.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,975.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,778.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,778.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,877.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,975.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,877.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,975.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,975.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,481.89
|
| Rate for Payer: Healthfirst Commercial |
$1,975.86
|
| Rate for Payer: Healthfirst Essential Plan |
$4,445.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,877.07
|
| Rate for Payer: Healthfirst QHP |
$1,975.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,383.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,975.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,679.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,383.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,975.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,481.89
|
| Rate for Payer: SOMOS Essential |
$1,481.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,975.86
|
|
|
PR BYP OTH/THN VEIN AORTOBI-ILIAC
|
Professional
|
Both
|
$7,709.35
|
|
|
Service Code
|
HCPCS 35638
|
| Min. Negotiated Rate |
$1,421.32 |
| Max. Negotiated Rate |
$4,568.51 |
| Rate for Payer: Cash Price |
$2,039.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,030.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,827.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,827.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,928.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,030.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,928.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,030.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,030.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,522.84
|
| Rate for Payer: Healthfirst Commercial |
$2,030.45
|
| Rate for Payer: Healthfirst Essential Plan |
$4,568.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,928.93
|
| Rate for Payer: Healthfirst QHP |
$2,030.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,421.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,030.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,725.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,421.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,030.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,522.84
|
| Rate for Payer: SOMOS Essential |
$1,522.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,030.45
|
|
|
PR BYP OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL
|
Professional
|
Both
|
$8,208.62
|
|
|
Service Code
|
HCPCS 35631
|
| Min. Negotiated Rate |
$1,501.65 |
| Max. Negotiated Rate |
$4,826.74 |
| Rate for Payer: Cash Price |
$2,177.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,145.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,930.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,930.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,037.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,145.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,037.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,145.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,145.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,608.91
|
| Rate for Payer: Healthfirst Commercial |
$2,145.22
|
| Rate for Payer: Healthfirst Essential Plan |
$4,826.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,037.96
|
| Rate for Payer: Healthfirst QHP |
$2,145.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,501.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,145.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,823.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,501.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,145.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,608.91
|
| Rate for Payer: SOMOS Essential |
$1,608.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,145.22
|
|
|
PR BYP OTH/THN VEIN AORTOFEMORAL
|
Professional
|
Both
|
$6,889.82
|
|
|
Service Code
|
HCPCS 35647
|
| Min. Negotiated Rate |
$1,248.43 |
| Max. Negotiated Rate |
$4,012.81 |
| Rate for Payer: Cash Price |
$1,823.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,783.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,605.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,605.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,694.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,783.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,694.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,783.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,783.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,337.60
|
| Rate for Payer: Healthfirst Commercial |
$1,783.47
|
| Rate for Payer: Healthfirst Essential Plan |
$4,012.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,694.30
|
| Rate for Payer: Healthfirst QHP |
$1,783.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,248.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,783.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,515.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,248.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,783.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,337.60
|
| Rate for Payer: SOMOS Essential |
$1,337.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,783.47
|
|
|
PR BYP OTH/THN VEIN AORTOILIAC
|
Professional
|
Both
|
$7,377.62
|
|
|
Service Code
|
HCPCS 35637
|
| Min. Negotiated Rate |
$1,352.43 |
| Max. Negotiated Rate |
$4,347.11 |
| Rate for Payer: Cash Price |
$1,953.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,932.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,738.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,738.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,835.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,932.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,835.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,932.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,932.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,449.04
|
| Rate for Payer: Healthfirst Commercial |
$1,932.05
|
| Rate for Payer: Healthfirst Essential Plan |
$4,347.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,835.45
|
| Rate for Payer: Healthfirst QHP |
$1,932.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,352.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,932.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,642.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,352.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,932.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,449.04
|
| Rate for Payer: SOMOS Essential |
$1,449.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,932.05
|
|
|
PR BYP OTH/THN VEIN AXILLARY-AXILLARY
|
Professional
|
Both
|
$4,547.24
|
|
|
Service Code
|
HCPCS 35650
|
| Min. Negotiated Rate |
$833.90 |
| Max. Negotiated Rate |
$2,680.40 |
| Rate for Payer: Cash Price |
$1,203.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,191.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,072.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,072.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,131.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,191.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,131.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,191.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,191.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$893.47
|
| Rate for Payer: Healthfirst Commercial |
$1,191.29
|
| Rate for Payer: Healthfirst Essential Plan |
$2,680.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,131.73
|
| Rate for Payer: Healthfirst QHP |
$1,191.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$833.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,191.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,012.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$833.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,191.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$893.47
|
| Rate for Payer: SOMOS Essential |
$893.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,191.29
|
|
|
PR BYP OTH/THN VEIN AXILLARY-FEMORAL
|
Professional
|
Both
|
$4,876.24
|
|
|
Service Code
|
HCPCS 35621
|
| Min. Negotiated Rate |
$891.30 |
| Max. Negotiated Rate |
$2,864.90 |
| Rate for Payer: Cash Price |
$1,289.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,273.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,145.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,145.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,209.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,273.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,209.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,273.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,273.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$954.97
|
| Rate for Payer: Healthfirst Commercial |
$1,273.29
|
| Rate for Payer: Healthfirst Essential Plan |
$2,864.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,209.63
|
| Rate for Payer: Healthfirst QHP |
$1,273.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$891.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,273.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,082.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$891.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,273.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$954.97
|
| Rate for Payer: SOMOS Essential |
$954.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,273.29
|
|
|
PR BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL
|
Professional
|
Both
|
$6,054.06
|
|
|
Service Code
|
HCPCS 35654
|
| Min. Negotiated Rate |
$1,111.70 |
| Max. Negotiated Rate |
$3,573.34 |
| Rate for Payer: Cash Price |
$1,603.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,588.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,429.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,429.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,508.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,588.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,508.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,588.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,588.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,191.11
|
| Rate for Payer: Healthfirst Commercial |
$1,588.15
|
| Rate for Payer: Healthfirst Essential Plan |
$3,573.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,508.74
|
| Rate for Payer: Healthfirst QHP |
$1,588.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,111.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,588.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,349.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,111.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,588.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,191.11
|
| Rate for Payer: SOMOS Essential |
$1,191.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,588.15
|
|
|
PR BYP OTH/THN VEIN AXILLARY-POPLITEAL/-TIBIAL
|
Professional
|
Both
|
$5,851.41
|
|
|
Service Code
|
HCPCS 35623
|
| Min. Negotiated Rate |
$1,073.42 |
| Max. Negotiated Rate |
$3,450.28 |
| Rate for Payer: Cash Price |
$1,548.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,533.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,380.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,380.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,456.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,533.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,456.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,533.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,533.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,150.10
|
| Rate for Payer: Healthfirst Commercial |
$1,533.46
|
| Rate for Payer: Healthfirst Essential Plan |
$3,450.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,456.79
|
| Rate for Payer: Healthfirst QHP |
$1,533.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,073.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,533.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,303.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,073.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,533.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,150.10
|
| Rate for Payer: SOMOS Essential |
$1,150.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,533.46
|
|
