|
PR BYP OTH/THN VEIN CAROTID-SUBCLAVIAN
|
Professional
|
Both
|
$5,206.57
|
|
|
Service Code
|
HCPCS 35606
|
| Min. Negotiated Rate |
$955.66 |
| Max. Negotiated Rate |
$3,071.77 |
| Rate for Payer: Cash Price |
$1,384.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,365.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,228.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,228.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,296.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,365.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,296.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,365.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,365.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,023.92
|
| Rate for Payer: Healthfirst Commercial |
$1,365.23
|
| Rate for Payer: Healthfirst Essential Plan |
$3,071.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,296.97
|
| Rate for Payer: Healthfirst QHP |
$1,365.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$955.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,365.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,160.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$955.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,365.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,023.92
|
| Rate for Payer: SOMOS Essential |
$1,023.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,365.23
|
|
|
PR BYP OTH/THN VEIN CAROTID-VERTEBRAL
|
Professional
|
Both
|
$4,395.72
|
|
|
Service Code
|
HCPCS 35642
|
| Min. Negotiated Rate |
$808.89 |
| Max. Negotiated Rate |
$2,600.01 |
| Rate for Payer: Cash Price |
$1,165.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,155.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,040.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,040.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,097.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,155.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,097.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,155.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,155.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$866.67
|
| Rate for Payer: Healthfirst Commercial |
$1,155.56
|
| Rate for Payer: Healthfirst Essential Plan |
$2,600.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,097.78
|
| Rate for Payer: Healthfirst QHP |
$1,155.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$808.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,155.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$982.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$808.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,155.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$866.67
|
| Rate for Payer: SOMOS Essential |
$866.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,155.56
|
|
|
PR BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID
|
Professional
|
Both
|
$6,235.71
|
|
|
Service Code
|
HCPCS 35601
|
| Min. Negotiated Rate |
$1,145.76 |
| Max. Negotiated Rate |
$3,682.80 |
| Rate for Payer: Cash Price |
$1,648.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,636.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,473.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,473.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,554.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,636.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,554.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,636.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,636.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,227.60
|
| Rate for Payer: Healthfirst Commercial |
$1,636.80
|
| Rate for Payer: Healthfirst Essential Plan |
$3,682.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,554.96
|
| Rate for Payer: Healthfirst QHP |
$1,636.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,145.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,636.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,391.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,145.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,636.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,227.60
|
| Rate for Payer: SOMOS Essential |
$1,227.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,636.80
|
|
|
PR BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL
|
Professional
|
Both
|
$5,717.29
|
|
|
Service Code
|
HCPCS 35666
|
| Min. Negotiated Rate |
$1,044.64 |
| Max. Negotiated Rate |
$3,357.76 |
| Rate for Payer: Cash Price |
$1,514.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,492.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,343.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,343.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,417.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,492.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,417.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,492.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,492.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,119.26
|
| Rate for Payer: Healthfirst Commercial |
$1,492.34
|
| Rate for Payer: Healthfirst Essential Plan |
$3,357.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,417.72
|
| Rate for Payer: Healthfirst QHP |
$1,492.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,044.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,492.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,268.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,044.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,492.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,119.26
|
| Rate for Payer: SOMOS Essential |
$1,119.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,492.34
|
|
|
PR BYP OTH/THN VEIN FEMORAL-FEMORAL
|
Professional
|
Both
|
$4,809.39
|
|
|
Service Code
|
HCPCS 35661
|
| Min. Negotiated Rate |
$881.24 |
| Max. Negotiated Rate |
$2,832.57 |
| Rate for Payer: Cash Price |
$1,273.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,258.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,133.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,133.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,195.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,258.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,195.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,258.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,258.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$944.19
|
| Rate for Payer: Healthfirst Commercial |
$1,258.92
|
| Rate for Payer: Healthfirst Essential Plan |
$2,832.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,195.97
|
| Rate for Payer: Healthfirst QHP |
$1,258.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$881.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,258.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,070.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$881.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,258.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$944.19
|
| Rate for Payer: SOMOS Essential |
$944.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,258.92
|
|
|
PR BYP OTH/THN VEIN FEMORAL-POPLITEAL
|
Professional
|
Both
|
$4,770.82
|
|
|
Service Code
|
HCPCS 35656
|
| Min. Negotiated Rate |
$871.58 |
| Max. Negotiated Rate |
$2,801.50 |
| Rate for Payer: Cash Price |
$1,261.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,245.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,120.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,120.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,182.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,245.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,182.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,245.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,245.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$933.83
|
| Rate for Payer: Healthfirst Commercial |
$1,245.11
|
| Rate for Payer: Healthfirst Essential Plan |
$2,801.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,182.85
|
| Rate for Payer: Healthfirst QHP |
$1,245.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$871.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,245.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,058.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$871.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,245.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$933.83
|
| Rate for Payer: SOMOS Essential |
$933.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,245.11
|
|
|
PR BYP OTH/THN VEIN ILIOFEMORAL
|
Professional
|
Both
|
$5,201.98
|
|
|
Service Code
|
HCPCS 35665
|
| Min. Negotiated Rate |
$953.61 |
| Max. Negotiated Rate |
$3,065.18 |
| Rate for Payer: Cash Price |
$1,379.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,362.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,226.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,294.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,362.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,294.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,362.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,362.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,021.73
|
| Rate for Payer: Healthfirst Commercial |
$1,362.30
|
| Rate for Payer: Healthfirst Essential Plan |
$3,065.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,294.18
|
| Rate for Payer: Healthfirst QHP |
$1,362.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$953.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,362.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,157.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$953.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,362.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,021.73
|
| Rate for Payer: SOMOS Essential |
$1,021.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,362.30
|
|
|
PR BYP OTH/THN VEIN ILIOILIAC
|
Professional
|
Both
|
$5,419.37
|
|
|
Service Code
|
HCPCS 35663
|
| Min. Negotiated Rate |
$995.11 |
| Max. Negotiated Rate |
$3,198.55 |
| Rate for Payer: Cash Price |
$1,437.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,421.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,279.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,279.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,350.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,421.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,350.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,421.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,421.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,066.18
|
| Rate for Payer: Healthfirst Commercial |
$1,421.58
|
| Rate for Payer: Healthfirst Essential Plan |
$3,198.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,350.50
|
| Rate for Payer: Healthfirst QHP |
$1,421.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$995.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,421.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,208.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$995.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,421.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,066.18
|
| Rate for Payer: SOMOS Essential |
$1,066.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,421.58
|
|
|
PR BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART
|
Professional
|
Both
|
$5,035.98
|
|
|
Service Code
|
HCPCS 35671
|
| Min. Negotiated Rate |
$916.19 |
| Max. Negotiated Rate |
$2,944.89 |
| Rate for Payer: Cash Price |
$1,332.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,308.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,177.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,177.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,243.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,308.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,243.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,308.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,308.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$981.63
|
| Rate for Payer: Healthfirst Commercial |
$1,308.84
|
| Rate for Payer: Healthfirst Essential Plan |
$2,944.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,243.40
|
| Rate for Payer: Healthfirst QHP |
$1,308.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$916.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,308.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,112.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$916.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,308.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$981.63
|
| Rate for Payer: SOMOS Essential |
$981.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,308.84
|
|
|
PR BYP OTH/THN VEIN SPLENORENAL
|
Professional
|
Both
|
$7,099.65
|
|
|
Service Code
|
HCPCS 35636
|
| Min. Negotiated Rate |
$1,300.72 |
| Max. Negotiated Rate |
$4,180.88 |
| Rate for Payer: Cash Price |
$1,878.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,672.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,672.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,765.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,765.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,858.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,393.63
|
| Rate for Payer: Healthfirst Commercial |
$1,858.17
|
| Rate for Payer: Healthfirst Essential Plan |
$4,180.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,765.26
|
| Rate for Payer: Healthfirst QHP |
$1,858.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,300.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,858.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,579.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,300.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,393.63
|
| Rate for Payer: SOMOS Essential |
$1,393.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.17
|
|
|
PR BYP OTH/THN VEIN SUBCLAVIAN-AXILLARY
|
Professional
|
Both
|
$4,901.96
|
|
|
Service Code
|
HCPCS 35616
|
| Min. Negotiated Rate |
$899.87 |
| Max. Negotiated Rate |
$2,892.44 |
| Rate for Payer: Cash Price |
$1,298.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,285.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,156.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,156.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,221.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,285.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,221.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,285.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,285.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$964.15
|
| Rate for Payer: Healthfirst Commercial |
$1,285.53
|
| Rate for Payer: Healthfirst Essential Plan |
$2,892.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,221.25
|
| Rate for Payer: Healthfirst QHP |
$1,285.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$899.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,285.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,092.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$899.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,285.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$964.15
|
| Rate for Payer: SOMOS Essential |
$964.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,285.53
|
|
|
PR BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN
|
Professional
|
Both
|
$4,652.27
|
|
|
Service Code
|
HCPCS 35612
|
| Min. Negotiated Rate |
$854.39 |
| Max. Negotiated Rate |
$2,746.26 |
| Rate for Payer: Cash Price |
$1,233.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,220.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,098.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,098.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,159.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,220.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,159.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,220.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,220.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$915.42
|
| Rate for Payer: Healthfirst Commercial |
$1,220.56
|
| Rate for Payer: Healthfirst Essential Plan |
$2,746.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,159.53
|
| Rate for Payer: Healthfirst QHP |
$1,220.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$854.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,220.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,037.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$854.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,220.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$915.42
|
| Rate for Payer: SOMOS Essential |
$915.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,220.56
|
|
|
PR BYP OTH/THN VEIN SUBCLAVIAN-VERTEBRAL
|
Professional
|
Both
|
$4,215.65
|
|
|
Service Code
|
HCPCS 35645
|
| Min. Negotiated Rate |
$773.85 |
| Max. Negotiated Rate |
$2,487.38 |
| Rate for Payer: Cash Price |
$1,117.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,105.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$994.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$994.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,050.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,105.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,050.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,105.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,105.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$829.12
|
| Rate for Payer: Healthfirst Commercial |
$1,105.50
|
| Rate for Payer: Healthfirst Essential Plan |
$2,487.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,050.22
|
| Rate for Payer: Healthfirst QHP |
$1,105.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$773.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,105.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$939.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$773.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,105.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$829.12
|
| Rate for Payer: SOMOS Essential |
$829.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,105.50
|
|
|
PR BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL
|
Professional
|
Both
|
$6,551.58
|
|
|
Service Code
|
HCPCS 35570
|
| Min. Negotiated Rate |
$1,201.75 |
| Max. Negotiated Rate |
$3,862.76 |
| Rate for Payer: Cash Price |
$1,737.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,716.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,545.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,545.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,630.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,716.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,630.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,716.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,716.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,287.59
|
| Rate for Payer: Healthfirst Commercial |
$1,716.78
|
| Rate for Payer: Healthfirst Essential Plan |
$3,862.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,630.94
|
| Rate for Payer: Healthfirst QHP |
$1,716.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,201.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,716.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,459.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,201.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,716.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,287.59
|
| Rate for Payer: SOMOS Essential |
$1,287.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,716.78
|
|
|
PR BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL
|
Professional
|
Both
|
$5,883.19
|
|
|
Service Code
|
HCPCS 35571
|
| Min. Negotiated Rate |
$1,076.79 |
| Max. Negotiated Rate |
$3,461.11 |
| Rate for Payer: Cash Price |
$1,556.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,538.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,384.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,384.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,461.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,538.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,461.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,538.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,538.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,153.70
|
| Rate for Payer: Healthfirst Commercial |
$1,538.27
|
| Rate for Payer: Healthfirst Essential Plan |
$3,461.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,461.36
|
| Rate for Payer: Healthfirst QHP |
$1,538.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,076.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,538.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,307.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,076.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,538.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,153.70
|
| Rate for Payer: SOMOS Essential |
$1,153.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,538.27
|
|
|
PR CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS
|
Professional
|
Both
|
$11,633.79
|
|
|
Service Code
|
HCPCS 33536
|
| Min. Negotiated Rate |
$2,147.93 |
| Max. Negotiated Rate |
$6,904.06 |
| Rate for Payer: Cash Price |
$3,096.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,068.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,761.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,761.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,915.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,068.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,915.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,068.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,068.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,301.35
|
| Rate for Payer: Healthfirst Commercial |
$3,068.47
|
| Rate for Payer: Healthfirst Essential Plan |
$6,904.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,915.05
|
| Rate for Payer: Healthfirst QHP |
$3,068.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,147.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,068.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,608.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,147.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,068.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,301.35
|
| Rate for Payer: SOMOS Essential |
$2,301.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,068.47
|
|
|
PR CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT
|
Professional
|
Both
|
$8,292.10
|
|
|
Service Code
|
HCPCS 33533
|
| Min. Negotiated Rate |
$1,528.78 |
| Max. Negotiated Rate |
$4,913.93 |
| Rate for Payer: Cash Price |
$2,204.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,183.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,965.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,965.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,074.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,183.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,074.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,183.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,183.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,637.98
|
| Rate for Payer: Healthfirst Commercial |
$2,183.97
|
| Rate for Payer: Healthfirst Essential Plan |
$4,913.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,074.77
|
| Rate for Payer: Healthfirst QHP |
$2,183.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,528.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,183.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,856.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,528.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,183.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,637.98
|
| Rate for Payer: SOMOS Essential |
$1,637.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,183.97
|
|
|
PR CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS
|
Professional
|
Both
|
$10,813.25
|
|
|
Service Code
|
HCPCS 33535
|
| Min. Negotiated Rate |
$1,993.51 |
| Max. Negotiated Rate |
$6,407.71 |
| Rate for Payer: Cash Price |
$2,873.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,847.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,563.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,563.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,705.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,847.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,705.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,847.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,847.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,135.90
|
| Rate for Payer: Healthfirst Commercial |
$2,847.87
|
| Rate for Payer: Healthfirst Essential Plan |
$6,407.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,705.48
|
| Rate for Payer: Healthfirst QHP |
$2,847.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,993.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,847.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,420.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,993.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,847.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,135.90
|
| Rate for Payer: SOMOS Essential |
$2,135.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,847.87
|
|
|
PR CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS
|
Professional
|
Both
|
$9,729.27
|
|
|
Service Code
|
HCPCS 33534
|
| Min. Negotiated Rate |
$1,795.86 |
| Max. Negotiated Rate |
$5,772.40 |
| Rate for Payer: Cash Price |
$2,588.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,565.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,308.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,308.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,437.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,565.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,437.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,565.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,565.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,924.13
|
| Rate for Payer: Healthfirst Commercial |
$2,565.51
|
| Rate for Payer: Healthfirst Essential Plan |
$5,772.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,437.23
|
| Rate for Payer: Healthfirst QHP |
$2,565.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,795.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,565.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,180.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,795.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,565.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,924.13
|
| Rate for Payer: SOMOS Essential |
$1,924.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,565.51
|
|
|
PR CAFFEINE HALOTHNE CONTRCTN TEST MAL HYPERTHRM
|
Professional
|
Both
|
$259.25
|
|
|
Service Code
|
HCPCS 89049
|
| Min. Negotiated Rate |
$48.18 |
| Max. Negotiated Rate |
$154.87 |
| Rate for Payer: Cash Price |
$69.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.62
|
| Rate for Payer: Healthfirst Commercial |
$68.83
|
| Rate for Payer: Healthfirst Essential Plan |
$154.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.39
|
| Rate for Payer: Healthfirst QHP |
$68.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.62
|
| Rate for Payer: SOMOS Essential |
$51.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.83
|
|
|
PR CALORIC VESTIBULAR TEST W/REC BI BITHERMAL
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 92537 26
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$74.09 |
| Rate for Payer: Amida Care Medicaid |
$26.02
|
| Rate for Payer: Cash Price |
$33.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.70
|
| Rate for Payer: Healthfirst Commercial |
$32.93
|
| Rate for Payer: Healthfirst Essential Plan |
$74.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.28
|
| Rate for Payer: Healthfirst QHP |
$32.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.70
|
| Rate for Payer: SOMOS Essential |
$24.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.93
|
|
|
PR CALORIC VESTIBULAR TEST W/REC BI BITHERMAL
|
Professional
|
Both
|
$42.98
|
|
|
Service Code
|
HCPCS 92537 TC
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$26.02 |
| Rate for Payer: Amida Care Medicaid |
$26.02
|
| Rate for Payer: Cash Price |
$11.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.74
|
| Rate for Payer: Healthfirst Commercial |
$10.32
|
| Rate for Payer: Healthfirst Essential Plan |
$23.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.80
|
| Rate for Payer: Healthfirst QHP |
$10.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.74
|
| Rate for Payer: SOMOS Essential |
$7.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.32
|
|
|
PR CALORIC VESTIBULAR TEST W/REC BI BITHERMAL
|
Professional
|
Both
|
$164.01
|
|
|
Service Code
|
HCPCS 92537
|
| Min. Negotiated Rate |
$26.02 |
| Max. Negotiated Rate |
$97.31 |
| Rate for Payer: Amida Care Medicaid |
$26.02
|
| Rate for Payer: Cash Price |
$44.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.44
|
| Rate for Payer: Healthfirst Commercial |
$43.25
|
| Rate for Payer: Healthfirst Essential Plan |
$97.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.09
|
| Rate for Payer: Healthfirst QHP |
$43.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.44
|
| Rate for Payer: SOMOS Essential |
$32.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.25
|
|
|
PR CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL
|
Professional
|
Both
|
$63.32
|
|
|
Service Code
|
HCPCS 92538 26
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$38.61 |
| Rate for Payer: Amida Care Medicaid |
$13.28
|
| Rate for Payer: Cash Price |
$17.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.87
|
| Rate for Payer: Healthfirst Commercial |
$17.16
|
| Rate for Payer: Healthfirst Essential Plan |
$38.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.30
|
| Rate for Payer: Healthfirst QHP |
$17.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.87
|
| Rate for Payer: SOMOS Essential |
$12.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.16
|
|
|
PR CALORIC VESTIBULAR TEST W/REC BI MONOTHERMAL
|
Professional
|
Both
|
$93.35
|
|
|
Service Code
|
HCPCS 92538
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$55.73 |
| Rate for Payer: Amida Care Medicaid |
$13.28
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.58
|
| Rate for Payer: Healthfirst Commercial |
$24.77
|
| Rate for Payer: Healthfirst Essential Plan |
$55.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.53
|
| Rate for Payer: Healthfirst QHP |
$24.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.58
|
| Rate for Payer: SOMOS Essential |
$18.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.77
|
|
