|
PR DIR RPR ANEURYSM VERTEBRAL ARTERY
|
Professional
|
Both
|
$4,432.72
|
|
|
Service Code
|
HCPCS 35005
|
| Min. Negotiated Rate |
$814.43 |
| Max. Negotiated Rate |
$2,617.81 |
| Rate for Payer: Cash Price |
$1,175.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,163.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,047.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,047.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,105.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,163.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,105.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,163.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,163.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$872.60
|
| Rate for Payer: Healthfirst Commercial |
$1,163.47
|
| Rate for Payer: Healthfirst Essential Plan |
$2,617.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,105.30
|
| Rate for Payer: Healthfirst QHP |
$1,163.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$814.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,163.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$988.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$814.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,163.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$872.60
|
| Rate for Payer: SOMOS Essential |
$872.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,163.47
|
|
|
PR DIR RPR RUPTD ANEURSM ABDOM AORTA W/VISCERA VSLS
|
Professional
|
Both
|
$11,483.15
|
|
|
Service Code
|
HCPCS 35092
|
| Min. Negotiated Rate |
$2,109.96 |
| Max. Negotiated Rate |
$6,782.02 |
| Rate for Payer: Cash Price |
$3,053.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,014.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,712.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,712.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,863.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,014.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,863.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,014.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,014.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,260.67
|
| Rate for Payer: Healthfirst Commercial |
$3,014.23
|
| Rate for Payer: Healthfirst Essential Plan |
$6,782.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,863.52
|
| Rate for Payer: Healthfirst QHP |
$3,014.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,109.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,014.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,562.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,109.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,014.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,260.67
|
| Rate for Payer: SOMOS Essential |
$2,260.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,014.23
|
|
|
PR DIR RPR RUPTD ANEURSM HEPATIC/CELIAC/RENAL/MESEN
|
Professional
|
Both
|
$8,407.60
|
|
|
Service Code
|
HCPCS 35122
|
| Min. Negotiated Rate |
$1,540.59 |
| Max. Negotiated Rate |
$4,951.89 |
| Rate for Payer: Cash Price |
$2,227.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,200.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,980.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,980.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,090.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,200.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,090.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,200.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,200.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,650.63
|
| Rate for Payer: Healthfirst Commercial |
$2,200.84
|
| Rate for Payer: Healthfirst Essential Plan |
$4,951.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,090.80
|
| Rate for Payer: Healthfirst QHP |
$2,200.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,540.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,200.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,870.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,540.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,200.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,650.63
|
| Rate for Payer: SOMOS Essential |
$1,650.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,200.84
|
|
|
PR DIR RPR RUPTD ANEURYSM ABDOM AORTA W/ILIAC VSLS
|
Professional
|
Both
|
$9,876.62
|
|
|
Service Code
|
HCPCS 35103
|
| Min. Negotiated Rate |
$1,765.20 |
| Max. Negotiated Rate |
$5,673.87 |
| Rate for Payer: Cash Price |
$2,609.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,521.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,269.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,269.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,395.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,521.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,395.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,521.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,521.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,891.29
|
| Rate for Payer: Healthfirst Commercial |
$2,521.72
|
| Rate for Payer: Healthfirst Essential Plan |
$5,673.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,395.63
|
| Rate for Payer: Healthfirst QHP |
$2,521.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,765.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,521.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,143.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,765.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,521.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,891.29
|
| Rate for Payer: SOMOS Essential |
$1,891.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,521.72
|
|
|
PR DIR RPR RUPTD ANEURYSM ABDOMINAL AORTA
|
Professional
|
Both
|
$9,609.88
|
|
|
Service Code
|
HCPCS 35082
|
| Min. Negotiated Rate |
$1,762.41 |
| Max. Negotiated Rate |
$5,664.89 |
| Rate for Payer: Cash Price |
$2,542.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,517.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,265.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,265.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,391.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,517.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,391.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,517.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,517.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,888.30
|
| Rate for Payer: Healthfirst Commercial |
$2,517.73
|
| Rate for Payer: Healthfirst Essential Plan |
$5,664.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,391.84
|
| Rate for Payer: Healthfirst QHP |
$2,517.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,762.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,517.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,140.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,762.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,517.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,888.30
|
| Rate for Payer: SOMOS Essential |
$1,888.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,517.73
|
|
|
PR DIR RPR RUPTD ANEURYSM AXIL-BRACHIAL ARM INCIS
|
Professional
|
Both
|
$5,643.12
|
|
|
Service Code
|
HCPCS 35013
|
| Min. Negotiated Rate |
$967.60 |
| Max. Negotiated Rate |
$3,110.15 |
| Rate for Payer: Cash Price |
$1,496.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,382.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,244.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,244.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,313.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,382.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,313.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,382.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,382.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,036.72
|
| Rate for Payer: Healthfirst Commercial |
$1,382.29
|
| Rate for Payer: Healthfirst Essential Plan |
$3,110.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,313.18
|
| Rate for Payer: Healthfirst QHP |
$1,382.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$967.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,382.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,174.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$967.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,382.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,036.72
|
| Rate for Payer: SOMOS Essential |
$1,036.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,382.29
|
|
|
PR DIR RPR RUPTD ANEURYSM CAROTID-SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$5,062.75
|
|
|
Service Code
|
HCPCS 35002
|
| Min. Negotiated Rate |
$929.68 |
| Max. Negotiated Rate |
$2,988.27 |
| Rate for Payer: Cash Price |
$1,342.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,328.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,195.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,195.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,261.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,328.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,261.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,328.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,328.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$996.09
|
| Rate for Payer: Healthfirst Commercial |
$1,328.12
|
| Rate for Payer: Healthfirst Essential Plan |
$2,988.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,261.71
|
| Rate for Payer: Healthfirst QHP |
$1,328.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$929.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,328.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,128.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$929.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,328.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$996.09
|
| Rate for Payer: SOMOS Essential |
$996.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,328.12
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$7,273.04
|
|
|
Service Code
|
HCPCS 35132
|
| Min. Negotiated Rate |
$1,332.68 |
| Max. Negotiated Rate |
$4,283.62 |
| Rate for Payer: Cash Price |
$1,925.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,903.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,713.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,713.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,808.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,903.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,808.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,903.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,903.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,427.87
|
| Rate for Payer: Healthfirst Commercial |
$1,903.83
|
| Rate for Payer: Healthfirst Essential Plan |
$4,283.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,808.64
|
| Rate for Payer: Healthfirst QHP |
$1,903.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,332.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,903.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,618.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,332.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,903.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,427.87
|
| Rate for Payer: SOMOS Essential |
$1,427.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,903.83
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRF COMMON FEMORAL ART
|
Professional
|
Both
|
$5,863.20
|
|
|
Service Code
|
HCPCS 35142
|
| Min. Negotiated Rate |
$1,073.94 |
| Max. Negotiated Rate |
$3,451.95 |
| Rate for Payer: Cash Price |
$1,553.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,534.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,380.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,380.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,457.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,534.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,457.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,534.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,534.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,150.65
|
| Rate for Payer: Healthfirst Commercial |
$1,534.20
|
| Rate for Payer: Healthfirst Essential Plan |
$3,451.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,457.49
|
| Rate for Payer: Healthfirst QHP |
$1,534.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,073.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,534.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,304.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,073.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,534.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,150.65
|
| Rate for Payer: SOMOS Essential |
$1,150.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,534.20
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRF POPLITEAL ARTERY
|
Professional
|
Both
|
$6,220.34
|
|
|
Service Code
|
HCPCS 35152
|
| Min. Negotiated Rate |
$1,140.89 |
| Max. Negotiated Rate |
$3,667.14 |
| Rate for Payer: Cash Price |
$1,646.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,629.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,466.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,466.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,548.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,629.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,548.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,629.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,629.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,222.38
|
| Rate for Payer: Healthfirst Commercial |
$1,629.84
|
| Rate for Payer: Healthfirst Essential Plan |
$3,667.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,548.35
|
| Rate for Payer: Healthfirst QHP |
$1,629.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,140.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,629.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,385.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,140.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,629.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,222.38
|
| Rate for Payer: SOMOS Essential |
$1,222.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,629.84
|
|
|
PR DIR RPR RUPTD ANEURYSM INNOMINATE/SUBCLAVIAN
|
Professional
|
Both
|
$6,351.45
|
|
|
Service Code
|
HCPCS 35022
|
| Min. Negotiated Rate |
$1,172.77 |
| Max. Negotiated Rate |
$3,769.63 |
| Rate for Payer: Cash Price |
$1,690.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,675.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,507.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,507.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,591.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,675.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,591.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,675.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,675.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,256.54
|
| Rate for Payer: Healthfirst Commercial |
$1,675.39
|
| Rate for Payer: Healthfirst Essential Plan |
$3,769.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,591.62
|
| Rate for Payer: Healthfirst QHP |
$1,675.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,172.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,675.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,424.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,172.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,675.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,256.54
|
| Rate for Payer: SOMOS Essential |
$1,256.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,675.39
|
|
|
PR DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY
|
Professional
|
Both
|
$4,308.12
|
|
|
Service Code
|
HCPCS 35045
|
| Min. Negotiated Rate |
$788.92 |
| Max. Negotiated Rate |
$2,535.82 |
| Rate for Payer: Cash Price |
$1,141.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,127.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,014.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,014.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,070.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,127.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,070.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,127.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,127.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$845.27
|
| Rate for Payer: Healthfirst Commercial |
$1,127.03
|
| Rate for Payer: Healthfirst Essential Plan |
$2,535.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,070.68
|
| Rate for Payer: Healthfirst QHP |
$1,127.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$788.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,127.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$957.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$788.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,127.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$845.27
|
| Rate for Payer: SOMOS Essential |
$845.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,127.03
|
|
|
PR DIR RPR RUPTD ANEURYSM SPLENIC ARTERY
|
Professional
|
Both
|
$7,273.04
|
|
|
Service Code
|
HCPCS 35112
|
| Min. Negotiated Rate |
$1,332.68 |
| Max. Negotiated Rate |
$4,283.62 |
| Rate for Payer: Cash Price |
$1,925.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,903.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,713.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,713.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,808.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,903.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,808.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,903.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,903.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,427.87
|
| Rate for Payer: Healthfirst Commercial |
$1,903.83
|
| Rate for Payer: Healthfirst Essential Plan |
$4,283.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,808.64
|
| Rate for Payer: Healthfirst QHP |
$1,903.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,332.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,903.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,618.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,332.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,903.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,427.87
|
| Rate for Payer: SOMOS Essential |
$1,427.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,903.83
|
|
|
PR DISARTICULATION HIP
|
Professional
|
Both
|
$5,560.87
|
|
|
Service Code
|
HCPCS 27295
|
| Min. Negotiated Rate |
$1,039.10 |
| Max. Negotiated Rate |
$3,339.97 |
| Rate for Payer: Cash Price |
$1,499.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,484.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,335.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,335.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,410.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,484.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,410.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,484.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,484.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,113.32
|
| Rate for Payer: Healthfirst Commercial |
$1,484.43
|
| Rate for Payer: Healthfirst Essential Plan |
$3,339.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,410.21
|
| Rate for Payer: Healthfirst QHP |
$1,484.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,039.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,484.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,261.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,039.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,484.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,113.32
|
| Rate for Payer: SOMOS Essential |
$1,113.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,484.43
|
|
|
PR DISARTICULATION KNEE
|
Professional
|
Both
|
$3,107.69
|
|
|
Service Code
|
HCPCS 27598
|
| Min. Negotiated Rate |
$577.77 |
| Max. Negotiated Rate |
$1,857.13 |
| Rate for Payer: Cash Price |
$829.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$825.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$742.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$742.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$784.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$825.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$784.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$825.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$825.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$619.04
|
| Rate for Payer: Healthfirst Commercial |
$825.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,857.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$784.12
|
| Rate for Payer: Healthfirst QHP |
$825.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$577.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$825.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$701.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$577.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$825.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$619.04
|
| Rate for Payer: SOMOS Essential |
$619.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$825.39
|
|
|
PR DISARTICULATION SHOULDER
|
Professional
|
Both
|
$4,963.00
|
|
|
Service Code
|
HCPCS 23920
|
| Min. Negotiated Rate |
$933.47 |
| Max. Negotiated Rate |
$3,000.44 |
| Rate for Payer: Cash Price |
$1,340.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,333.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,200.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,200.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,266.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,333.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,266.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,333.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,333.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,000.15
|
| Rate for Payer: Healthfirst Commercial |
$1,333.53
|
| Rate for Payer: Healthfirst Essential Plan |
$3,000.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,266.85
|
| Rate for Payer: Healthfirst QHP |
$1,333.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$933.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,333.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,133.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$933.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,333.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,000.15
|
| Rate for Payer: SOMOS Essential |
$1,000.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,333.53
|
|
|
PR DISARTICULATION THROUGH WRIST
|
Professional
|
Both
|
$3,243.42
|
|
|
Service Code
|
HCPCS 25920
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$1,959.12 |
| Rate for Payer: Cash Price |
$875.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$870.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$783.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$783.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$827.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$870.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$827.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$870.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$870.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$653.04
|
| Rate for Payer: Healthfirst Commercial |
$870.72
|
| Rate for Payer: Healthfirst Essential Plan |
$1,959.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$827.18
|
| Rate for Payer: Healthfirst QHP |
$870.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$609.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$870.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$740.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$609.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$870.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$653.04
|
| Rate for Payer: SOMOS Essential |
$653.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$870.72
|
|
|
PR DISARTICULATION THRU WRIST RE-AMPUTATION
|
Professional
|
Both
|
$3,167.68
|
|
|
Service Code
|
HCPCS 25924
|
| Min. Negotiated Rate |
$594.38 |
| Max. Negotiated Rate |
$1,910.50 |
| Rate for Payer: Cash Price |
$855.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$849.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$764.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$764.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$806.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$849.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$806.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$849.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$849.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$636.83
|
| Rate for Payer: Healthfirst Commercial |
$849.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,910.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$806.65
|
| Rate for Payer: Healthfirst QHP |
$849.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$594.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$849.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$721.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$594.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$849.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$636.83
|
| Rate for Payer: SOMOS Essential |
$636.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$849.11
|
|
|
PR DISARTICULATION THRU WRIST SEC CLOSURE/SCAR REVJ
|
Professional
|
Both
|
$2,874.52
|
|
|
Service Code
|
HCPCS 25922
|
| Min. Negotiated Rate |
$539.17 |
| Max. Negotiated Rate |
$1,733.06 |
| Rate for Payer: Cash Price |
$777.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$770.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$693.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$693.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$731.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$770.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$731.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$770.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$770.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$577.69
|
| Rate for Payer: Healthfirst Commercial |
$770.25
|
| Rate for Payer: Healthfirst Essential Plan |
$1,733.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$731.74
|
| Rate for Payer: Healthfirst QHP |
$770.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$539.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$770.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$654.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$539.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$770.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$577.69
|
| Rate for Payer: SOMOS Essential |
$577.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$770.25
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC
|
Professional
|
Both
|
$6,318.48
|
|
|
Service Code
|
HCPCS 63075
|
| Min. Negotiated Rate |
$1,166.20 |
| Max. Negotiated Rate |
$3,748.50 |
| Rate for Payer: Cash Price |
$1,673.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,666.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,499.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,499.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,582.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,666.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,582.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,666.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,666.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,249.50
|
| Rate for Payer: Healthfirst Commercial |
$1,666.00
|
| Rate for Payer: Healthfirst Essential Plan |
$3,748.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,582.70
|
| Rate for Payer: Healthfirst QHP |
$1,666.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,166.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,666.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,416.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,166.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,666.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,249.50
|
| Rate for Payer: SOMOS Essential |
$1,249.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,666.00
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC
|
Professional
|
Both
|
$1,116.50
|
|
|
Service Code
|
HCPCS 63076
|
| Min. Negotiated Rate |
$207.10 |
| Max. Negotiated Rate |
$665.68 |
| Rate for Payer: Cash Price |
$293.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$295.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$266.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$266.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$281.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$281.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$221.90
|
| Rate for Payer: Healthfirst Commercial |
$295.86
|
| Rate for Payer: Healthfirst Essential Plan |
$665.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$281.07
|
| Rate for Payer: Healthfirst QHP |
$295.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$207.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$295.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$251.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$207.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$295.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$221.90
|
| Rate for Payer: SOMOS Essential |
$221.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.86
|
|
|
PR DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC
|
Professional
|
Both
|
$7,126.60
|
|
|
Service Code
|
HCPCS 63077
|
| Min. Negotiated Rate |
$1,207.56 |
| Max. Negotiated Rate |
$3,881.45 |
| Rate for Payer: Cash Price |
$1,733.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,725.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,552.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,552.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,638.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,725.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,638.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,725.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,725.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,293.82
|
| Rate for Payer: Healthfirst Commercial |
$1,725.09
|
| Rate for Payer: Healthfirst Essential Plan |
$3,881.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,638.84
|
| Rate for Payer: Healthfirst QHP |
$1,725.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,207.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,725.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,466.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,207.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,725.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,293.82
|
| Rate for Payer: SOMOS Essential |
$1,293.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,725.09
|
|
|
PR DISCECTOMY ANT DCMPRN CORD THORACIC EA NTRSPC
|
Professional
|
Both
|
$999.11
|
|
|
Service Code
|
HCPCS 63078
|
| Min. Negotiated Rate |
$181.42 |
| Max. Negotiated Rate |
$583.13 |
| Rate for Payer: Cash Price |
$261.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$259.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$233.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$233.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$246.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$259.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$246.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$259.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$259.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.38
|
| Rate for Payer: Healthfirst Commercial |
$259.17
|
| Rate for Payer: Healthfirst Essential Plan |
$583.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.21
|
| Rate for Payer: Healthfirst QHP |
$259.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$181.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$259.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$220.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$181.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$259.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$194.38
|
| Rate for Payer: SOMOS Essential |
$194.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$259.17
|
|
|
PR DISCISSION SECONDARY MEMBRANOUS CATARACT
|
Professional
|
Both
|
$1,977.26
|
|
|
Service Code
|
HCPCS 66820
|
| Min. Negotiated Rate |
$366.44 |
| Max. Negotiated Rate |
$1,177.85 |
| Rate for Payer: Cash Price |
$539.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$523.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$471.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$471.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$497.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$523.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$497.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$523.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$523.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$392.62
|
| Rate for Payer: Healthfirst Commercial |
$523.49
|
| Rate for Payer: Healthfirst Essential Plan |
$1,177.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$497.32
|
| Rate for Payer: Healthfirst QHP |
$523.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$366.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$523.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$444.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$366.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$523.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$392.62
|
| Rate for Payer: SOMOS Essential |
$392.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$523.49
|
|
|
PR DISCISSION VITREOUS STRANS PARS PLANA APPROACH
|
Professional
|
Both
|
$2,315.67
|
|
|
Service Code
|
HCPCS 67030
|
| Min. Negotiated Rate |
$438.62 |
| Max. Negotiated Rate |
$1,409.85 |
| Rate for Payer: Cash Price |
$637.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$626.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$563.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$563.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$595.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$626.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$595.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$626.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$626.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$469.95
|
| Rate for Payer: Healthfirst Commercial |
$626.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,409.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$595.27
|
| Rate for Payer: Healthfirst QHP |
$626.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$438.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$626.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$532.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$438.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$626.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$469.95
|
| Rate for Payer: SOMOS Essential |
$469.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$626.60
|
|
