|
PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC
|
Professional
|
Both
|
$1,017.87
|
|
|
Service Code
|
HCPCS 58120
|
| Min. Negotiated Rate |
$190.24 |
| Max. Negotiated Rate |
$611.48 |
| Rate for Payer: Cash Price |
$275.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$271.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$244.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$258.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$258.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$203.83
|
| Rate for Payer: Healthfirst Commercial |
$271.77
|
| Rate for Payer: Healthfirst Essential Plan |
$611.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$258.18
|
| Rate for Payer: Healthfirst QHP |
$271.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$190.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$271.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$231.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$190.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$203.83
|
| Rate for Payer: SOMOS Essential |
$203.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$271.77
|
|
|
PR DILATION ESOPHAGUS GUIDE WIRE
|
Professional
|
Both
|
$365.16
|
|
|
Service Code
|
HCPCS 43453
|
| Min. Negotiated Rate |
$68.96 |
| Max. Negotiated Rate |
$221.67 |
| Rate for Payer: Cash Price |
$99.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.89
|
| Rate for Payer: Healthfirst Commercial |
$98.52
|
| Rate for Payer: Healthfirst Essential Plan |
$221.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.59
|
| Rate for Payer: Healthfirst QHP |
$98.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.89
|
| Rate for Payer: SOMOS Essential |
$73.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.52
|
|
|
PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS
|
Professional
|
Both
|
$337.65
|
|
|
Service Code
|
HCPCS 43450
|
| Min. Negotiated Rate |
$63.33 |
| Max. Negotiated Rate |
$203.56 |
| Rate for Payer: Cash Price |
$91.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.85
|
| Rate for Payer: Healthfirst Commercial |
$90.47
|
| Rate for Payer: Healthfirst Essential Plan |
$203.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.95
|
| Rate for Payer: Healthfirst QHP |
$90.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.85
|
| Rate for Payer: SOMOS Essential |
$67.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.47
|
|
|
PR DILATION LACRIMAL PUNCTUM W/WO IRRGATION
|
Professional
|
Both
|
$324.98
|
|
|
Service Code
|
HCPCS 68801
|
| Min. Negotiated Rate |
$62.53 |
| Max. Negotiated Rate |
$200.99 |
| Rate for Payer: Cash Price |
$91.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.00
|
| Rate for Payer: Healthfirst Commercial |
$89.33
|
| Rate for Payer: Healthfirst Essential Plan |
$200.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.86
|
| Rate for Payer: Healthfirst QHP |
$89.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.00
|
| Rate for Payer: SOMOS Essential |
$67.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.33
|
|
|
PR DILATION SALIVARY DUCT
|
Professional
|
Both
|
$253.05
|
|
|
Service Code
|
HCPCS 42650
|
| Min. Negotiated Rate |
$48.76 |
| Max. Negotiated Rate |
$156.71 |
| Rate for Payer: Cash Price |
$69.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.24
|
| Rate for Payer: Healthfirst Commercial |
$69.65
|
| Rate for Payer: Healthfirst Essential Plan |
$156.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.17
|
| Rate for Payer: Healthfirst QHP |
$69.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.24
|
| Rate for Payer: SOMOS Essential |
$52.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.65
|
|
|
PR DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$560.91
|
|
|
Service Code
|
HCPCS 57400
|
| Min. Negotiated Rate |
$105.85 |
| Max. Negotiated Rate |
$340.22 |
| Rate for Payer: Cash Price |
$152.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$151.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$136.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$136.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$151.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$151.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$151.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.41
|
| Rate for Payer: Healthfirst Commercial |
$151.21
|
| Rate for Payer: Healthfirst Essential Plan |
$340.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.65
|
| Rate for Payer: Healthfirst QHP |
$151.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$151.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$151.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.41
|
| Rate for Payer: SOMOS Essential |
$113.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.21
|
|
|
PR DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$840.35
|
|
|
Service Code
|
HCPCS 45910
|
| Min. Negotiated Rate |
$158.83 |
| Max. Negotiated Rate |
$510.52 |
| Rate for Payer: Cash Price |
$227.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$226.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$204.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$204.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.18
|
| Rate for Payer: Healthfirst Commercial |
$226.90
|
| Rate for Payer: Healthfirst Essential Plan |
$510.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.56
|
| Rate for Payer: Healthfirst QHP |
$226.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$226.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$226.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.18
|
| Rate for Payer: SOMOS Essential |
$170.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.90
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE 1ST
|
Professional
|
Both
|
$271.39
|
|
|
Service Code
|
HCPCS 53600
|
| Min. Negotiated Rate |
$50.77 |
| Max. Negotiated Rate |
$163.19 |
| Rate for Payer: Cash Price |
$72.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.40
|
| Rate for Payer: Healthfirst Commercial |
$72.53
|
| Rate for Payer: Healthfirst Essential Plan |
$163.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.90
|
| Rate for Payer: Healthfirst QHP |
$72.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.40
|
| Rate for Payer: SOMOS Essential |
$54.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.53
|
|
|
PR DILAT URETHRAL STRIX DILATOR MALE SBSQ
|
Professional
|
Both
|
$223.13
|
|
|
Service Code
|
HCPCS 53601
|
| Min. Negotiated Rate |
$42.57 |
| Max. Negotiated Rate |
$136.84 |
| Rate for Payer: Cash Price |
$60.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.62
|
| Rate for Payer: Healthfirst Commercial |
$60.82
|
| Rate for Payer: Healthfirst Essential Plan |
$136.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.78
|
| Rate for Payer: Healthfirst QHP |
$60.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.62
|
| Rate for Payer: SOMOS Essential |
$45.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.82
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST
|
Professional
|
Both
|
$361.27
|
|
|
Service Code
|
HCPCS 53620
|
| Min. Negotiated Rate |
$68.92 |
| Max. Negotiated Rate |
$221.51 |
| Rate for Payer: Cash Price |
$98.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.84
|
| Rate for Payer: Healthfirst Commercial |
$98.45
|
| Rate for Payer: Healthfirst Essential Plan |
$221.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.53
|
| Rate for Payer: Healthfirst QHP |
$98.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.84
|
| Rate for Payer: SOMOS Essential |
$73.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.45
|
|
|
PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ
|
Professional
|
Both
|
$300.41
|
|
|
Service Code
|
HCPCS 53621
|
| Min. Negotiated Rate |
$56.59 |
| Max. Negotiated Rate |
$181.91 |
| Rate for Payer: Cash Price |
$81.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.64
|
| Rate for Payer: Healthfirst Commercial |
$80.85
|
| Rate for Payer: Healthfirst Essential Plan |
$181.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.81
|
| Rate for Payer: Healthfirst QHP |
$80.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.64
|
| Rate for Payer: SOMOS Essential |
$60.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.85
|
|
|
PR DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES
|
Professional
|
Both
|
$270.10
|
|
|
Service Code
|
HCPCS 53605
|
| Min. Negotiated Rate |
$50.29 |
| Max. Negotiated Rate |
$161.64 |
| Rate for Payer: Cash Price |
$72.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.88
|
| Rate for Payer: Healthfirst Commercial |
$71.84
|
| Rate for Payer: Healthfirst Essential Plan |
$161.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.25
|
| Rate for Payer: Healthfirst QHP |
$71.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.88
|
| Rate for Payer: SOMOS Essential |
$53.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.84
|
|
|
PR DIRECT NASAL MUCOUS MEMBRANE TEST
|
Professional
|
Both
|
$120.61
|
|
|
Service Code
|
HCPCS 95065
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$77.38 |
| Rate for Payer: Amida Care Medicaid |
$9.51
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.79
|
| Rate for Payer: Healthfirst Commercial |
$34.39
|
| Rate for Payer: Healthfirst Essential Plan |
$77.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.67
|
| Rate for Payer: Healthfirst QHP |
$34.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.79
|
| Rate for Payer: SOMOS Essential |
$25.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.39
|
|
|
PR DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG
|
Professional
|
Both
|
$7,702.59
|
|
|
Service Code
|
HCPCS 33645
|
| Min. Negotiated Rate |
$1,417.44 |
| Max. Negotiated Rate |
$4,556.07 |
| Rate for Payer: Cash Price |
$2,045.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,024.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,822.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,822.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,923.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,024.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,923.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,024.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,024.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,518.69
|
| Rate for Payer: Healthfirst Commercial |
$2,024.92
|
| Rate for Payer: Healthfirst Essential Plan |
$4,556.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,923.67
|
| Rate for Payer: Healthfirst QHP |
$2,024.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,417.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,024.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,721.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,417.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,024.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,518.69
|
| Rate for Payer: SOMOS Essential |
$1,518.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,024.92
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS
|
Professional
|
Both
|
$8,339.45
|
|
|
Service Code
|
HCPCS 35102
|
| Min. Negotiated Rate |
$1,528.67 |
| Max. Negotiated Rate |
$4,913.60 |
| Rate for Payer: Cash Price |
$2,214.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,183.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,965.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,965.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,074.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,183.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,074.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,183.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,183.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,637.87
|
| Rate for Payer: Healthfirst Commercial |
$2,183.82
|
| Rate for Payer: Healthfirst Essential Plan |
$4,913.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,074.63
|
| Rate for Payer: Healthfirst QHP |
$2,183.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,528.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,183.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,856.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,528.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,183.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,637.87
|
| Rate for Payer: SOMOS Essential |
$1,637.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,183.82
|
|
|
PR DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS
|
Professional
|
Both
|
$7,915.78
|
|
|
Service Code
|
HCPCS 35091
|
| Min. Negotiated Rate |
$1,449.04 |
| Max. Negotiated Rate |
$4,657.61 |
| Rate for Payer: Cash Price |
$2,092.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,070.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,863.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,863.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,966.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,070.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,966.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,070.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,070.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,552.54
|
| Rate for Payer: Healthfirst Commercial |
$2,070.05
|
| Rate for Payer: Healthfirst Essential Plan |
$4,657.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,966.55
|
| Rate for Payer: Healthfirst QHP |
$2,070.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,449.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,070.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,759.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,449.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,070.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,552.54
|
| Rate for Payer: SOMOS Essential |
$1,552.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,070.05
|
|
|
PR DIR RPR ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$7,688.21
|
|
|
Service Code
|
HCPCS 35081
|
| Min. Negotiated Rate |
$1,406.12 |
| Max. Negotiated Rate |
$4,519.66 |
| Rate for Payer: Cash Price |
$2,036.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,008.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,807.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,807.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,908.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,008.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,908.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,008.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,008.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,506.56
|
| Rate for Payer: Healthfirst Commercial |
$2,008.74
|
| Rate for Payer: Healthfirst Essential Plan |
$4,519.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,908.30
|
| Rate for Payer: Healthfirst QHP |
$2,008.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,406.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,008.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,707.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,406.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,008.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,506.56
|
| Rate for Payer: SOMOS Essential |
$1,506.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,008.74
|
|
|
PR DIR RPR ANEURYSM AXIL-BRACHIAL ARM INCISION
|
Professional
|
Both
|
$4,496.52
|
|
|
Service Code
|
HCPCS 35011
|
| Min. Negotiated Rate |
$822.56 |
| Max. Negotiated Rate |
$2,643.95 |
| Rate for Payer: Cash Price |
$1,192.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,175.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,057.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,057.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,116.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,175.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,116.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,175.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,175.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$881.32
|
| Rate for Payer: Healthfirst Commercial |
$1,175.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,643.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,116.34
|
| Rate for Payer: Healthfirst QHP |
$1,175.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$822.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,175.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$998.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$822.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,175.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$881.32
|
| Rate for Payer: SOMOS Essential |
$881.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,175.09
|
|
|
PR DIR RPR ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$4,998.88
|
|
|
Service Code
|
HCPCS 35001
|
| Min. Negotiated Rate |
$903.52 |
| Max. Negotiated Rate |
$2,904.16 |
| Rate for Payer: Cash Price |
$1,323.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,290.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,161.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,161.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,226.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,290.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,226.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,290.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,290.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$968.05
|
| Rate for Payer: Healthfirst Commercial |
$1,290.74
|
| Rate for Payer: Healthfirst Essential Plan |
$2,904.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,226.20
|
| Rate for Payer: Healthfirst QHP |
$1,290.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$903.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,290.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,097.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$903.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,290.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$968.05
|
| Rate for Payer: SOMOS Essential |
$968.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,290.74
|
|
|
PR DIR RPR ANEURYSM & GRAFT COMMON FEMORAL ARTERY
|
Professional
|
Both
|
$4,857.58
|
|
|
Service Code
|
HCPCS 35141
|
| Min. Negotiated Rate |
$889.23 |
| Max. Negotiated Rate |
$2,858.24 |
| Rate for Payer: Cash Price |
$1,285.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,270.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,143.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,143.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,206.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,270.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,206.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,270.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,270.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$952.75
|
| Rate for Payer: Healthfirst Commercial |
$1,270.33
|
| Rate for Payer: Healthfirst Essential Plan |
$2,858.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,206.81
|
| Rate for Payer: Healthfirst QHP |
$1,270.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$889.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,270.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,079.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$889.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,270.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$952.75
|
| Rate for Payer: SOMOS Essential |
$952.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,270.33
|
|
|
PR DIR RPR ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$6,124.48
|
|
|
Service Code
|
HCPCS 35131
|
| Min. Negotiated Rate |
$1,128.03 |
| Max. Negotiated Rate |
$3,625.81 |
| Rate for Payer: Cash Price |
$1,626.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,611.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,450.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,450.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,530.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,611.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,530.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,611.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,611.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,208.60
|
| Rate for Payer: Healthfirst Commercial |
$1,611.47
|
| Rate for Payer: Healthfirst Essential Plan |
$3,625.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,530.90
|
| Rate for Payer: Healthfirst QHP |
$1,611.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,128.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,611.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,369.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,128.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,611.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,208.60
|
| Rate for Payer: SOMOS Essential |
$1,208.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,611.47
|
|
|
PR DIR RPR ANEURYSM & GRAFT POPLITEAL ARTERY
|
Professional
|
Both
|
$5,507.32
|
|
|
Service Code
|
HCPCS 35151
|
| Min. Negotiated Rate |
$1,007.93 |
| Max. Negotiated Rate |
$3,239.78 |
| Rate for Payer: Cash Price |
$1,462.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,439.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,295.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,295.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,367.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,439.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,367.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,439.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,439.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,079.92
|
| Rate for Payer: Healthfirst Commercial |
$1,439.90
|
| Rate for Payer: Healthfirst Essential Plan |
$3,239.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,367.90
|
| Rate for Payer: Healthfirst QHP |
$1,439.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,007.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,439.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,223.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,007.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,439.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,079.92
|
| Rate for Payer: SOMOS Essential |
$1,079.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,439.90
|
|
|
PR DIR RPR ANEURYSM HEPATIC/CELIAC/RENAL/MESENTERIC
|
Professional
|
Both
|
$7,033.01
|
|
|
Service Code
|
HCPCS 35121
|
| Min. Negotiated Rate |
$1,289.48 |
| Max. Negotiated Rate |
$4,144.75 |
| Rate for Payer: Cash Price |
$1,861.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,842.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,657.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,657.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,750.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,842.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,842.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,842.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,381.58
|
| Rate for Payer: Healthfirst Commercial |
$1,842.11
|
| Rate for Payer: Healthfirst Essential Plan |
$4,144.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,750.00
|
| Rate for Payer: Healthfirst QHP |
$1,842.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,289.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,842.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,565.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,289.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,842.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,381.58
|
| Rate for Payer: SOMOS Essential |
$1,381.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,842.11
|
|
|
PR DIR RPR ANEURYSM INNOMINATE/SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$5,555.17
|
|
|
Service Code
|
HCPCS 35021
|
| Min. Negotiated Rate |
$1,026.25 |
| Max. Negotiated Rate |
$3,298.66 |
| Rate for Payer: Cash Price |
$1,477.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,466.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,319.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,319.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,392.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,466.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,392.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,466.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,466.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,099.55
|
| Rate for Payer: Healthfirst Commercial |
$1,466.07
|
| Rate for Payer: Healthfirst Essential Plan |
$3,298.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,392.77
|
| Rate for Payer: Healthfirst QHP |
$1,466.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,026.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,466.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,246.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,026.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,466.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,099.55
|
| Rate for Payer: SOMOS Essential |
$1,099.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,466.07
|
|
|
PR DIR RPR ANEURYSM SPLENIC ARTERY
|
Professional
|
Both
|
$5,919.55
|
|
|
Service Code
|
HCPCS 35111
|
| Min. Negotiated Rate |
$1,084.91 |
| Max. Negotiated Rate |
$3,487.21 |
| Rate for Payer: Cash Price |
$1,566.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,549.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,394.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,394.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,472.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,549.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,472.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,549.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,549.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,162.40
|
| Rate for Payer: Healthfirst Commercial |
$1,549.87
|
| Rate for Payer: Healthfirst Essential Plan |
$3,487.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,472.38
|
| Rate for Payer: Healthfirst QHP |
$1,549.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,084.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,549.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,317.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,084.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,549.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,162.40
|
| Rate for Payer: SOMOS Essential |
$1,162.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,549.87
|
|
