|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$1,412.50
|
|
|
Service Code
|
HCPCS 95816 TC
|
| Min. Negotiated Rate |
$171.85 |
| Max. Negotiated Rate |
$871.94 |
| Rate for Payer: Amida Care Medicaid |
$171.85
|
| Rate for Payer: Cash Price |
$401.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$387.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$348.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$348.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$368.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$387.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$368.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$387.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$387.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$290.65
|
| Rate for Payer: Healthfirst Commercial |
$387.53
|
| Rate for Payer: Healthfirst Essential Plan |
$871.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$368.15
|
| Rate for Payer: Healthfirst QHP |
$387.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$271.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$387.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$329.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$271.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$387.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$290.65
|
| Rate for Payer: SOMOS Essential |
$290.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$387.53
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$222.39
|
|
|
Service Code
|
HCPCS 95816 26
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$171.85 |
| Rate for Payer: Amida Care Medicaid |
$171.85
|
| Rate for Payer: Cash Price |
$62.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.48
|
| Rate for Payer: Healthfirst Commercial |
$60.64
|
| Rate for Payer: Healthfirst Essential Plan |
$136.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.61
|
| Rate for Payer: Healthfirst QHP |
$60.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.48
|
| Rate for Payer: SOMOS Essential |
$45.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.64
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$1,634.89
|
|
|
Service Code
|
HCPCS 95816
|
| Min. Negotiated Rate |
$171.85 |
| Max. Negotiated Rate |
$1,008.36 |
| Rate for Payer: Amida Care Medicaid |
$171.85
|
| Rate for Payer: Cash Price |
$463.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$448.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$403.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$403.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$425.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$448.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$425.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$448.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$448.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$336.12
|
| Rate for Payer: Healthfirst Commercial |
$448.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,008.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$425.75
|
| Rate for Payer: Healthfirst QHP |
$448.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$313.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$448.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$380.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$313.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$448.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$336.12
|
| Rate for Payer: SOMOS Essential |
$336.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$448.16
|
|
|
PR ELECTROGASTROGRAPHY DX TRANSCUTANEOUS
|
Professional
|
Both
|
$103.67
|
|
|
Service Code
|
HCPCS 91132 26
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$63.18 |
| Rate for Payer: Cash Price |
$28.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.06
|
| Rate for Payer: Healthfirst Commercial |
$28.08
|
| Rate for Payer: Healthfirst Essential Plan |
$63.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.68
|
| Rate for Payer: Healthfirst QHP |
$28.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.06
|
| Rate for Payer: SOMOS Essential |
$21.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.08
|
|
|
PR ELECTROGASTROGRAPHY DX TRANSCUTANEOUS
|
Professional
|
Both
|
$1,914.78
|
|
|
Service Code
|
HCPCS 91132
|
| Min. Negotiated Rate |
$338.80 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Cash Price |
$513.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$484.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$435.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$435.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$459.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$484.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$459.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$484.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$484.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$363.00
|
| Rate for Payer: Healthfirst Commercial |
$484.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,089.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$459.80
|
| Rate for Payer: Healthfirst QHP |
$484.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$338.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$484.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$411.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$338.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$484.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$363.00
|
| Rate for Payer: SOMOS Essential |
$363.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$484.00
|
|
|
PR ELECTROGASTROGRAPHY DX TRANSCUTANEOUS
|
Professional
|
Both
|
$1,811.11
|
|
|
Service Code
|
HCPCS 91132 TC
|
| Min. Negotiated Rate |
$319.15 |
| Max. Negotiated Rate |
$1,025.84 |
| Rate for Payer: Cash Price |
$485.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$455.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$410.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$410.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$433.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$455.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$433.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$455.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$455.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$341.95
|
| Rate for Payer: Healthfirst Commercial |
$455.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,025.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$433.13
|
| Rate for Payer: Healthfirst QHP |
$455.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$319.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$455.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$387.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$319.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$455.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$341.95
|
| Rate for Payer: SOMOS Essential |
$341.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$455.93
|
|
|
PR ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG
|
Professional
|
Both
|
$129.82
|
|
|
Service Code
|
HCPCS 91133 26
|
| Min. Negotiated Rate |
$24.93 |
| Max. Negotiated Rate |
$80.14 |
| Rate for Payer: Cash Price |
$35.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.71
|
| Rate for Payer: Healthfirst Commercial |
$35.62
|
| Rate for Payer: Healthfirst Essential Plan |
$80.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.84
|
| Rate for Payer: Healthfirst QHP |
$35.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.71
|
| Rate for Payer: SOMOS Essential |
$26.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.62
|
|
|
PR ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG
|
Professional
|
Both
|
$1,882.97
|
|
|
Service Code
|
HCPCS 91133 TC
|
| Min. Negotiated Rate |
$330.29 |
| Max. Negotiated Rate |
$1,061.64 |
| Rate for Payer: Cash Price |
$503.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$471.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$424.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$424.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$448.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$471.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$448.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$471.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$471.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$353.88
|
| Rate for Payer: Healthfirst Commercial |
$471.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,061.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$448.25
|
| Rate for Payer: Healthfirst QHP |
$471.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$330.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$471.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$401.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$330.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$471.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$353.88
|
| Rate for Payer: SOMOS Essential |
$353.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$471.84
|
|
|
PR ELECTROGASTROGRAPHY DX TRANSCUT W/PROVOCTVE TSTG
|
Professional
|
Both
|
$2,012.82
|
|
|
Service Code
|
HCPCS 91133
|
| Min. Negotiated Rate |
$355.22 |
| Max. Negotiated Rate |
$1,141.79 |
| Rate for Payer: Cash Price |
$539.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$507.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$456.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$456.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$482.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$507.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$482.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$380.60
|
| Rate for Payer: Healthfirst Commercial |
$507.46
|
| Rate for Payer: Healthfirst Essential Plan |
$1,141.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$482.09
|
| Rate for Payer: Healthfirst QHP |
$507.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$355.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$507.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$431.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$355.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$507.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$380.60
|
| Rate for Payer: SOMOS Essential |
$380.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$507.46
|
|
|
PR ELECTROMAGNTIC TX FOR ULCERS
|
Professional
|
Both
|
$47.64
|
|
|
Service Code
|
HCPCS G0329
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$27.88 |
| Rate for Payer: Cash Price |
$12.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.29
|
| Rate for Payer: Healthfirst Commercial |
$12.39
|
| Rate for Payer: Healthfirst Essential Plan |
$27.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.77
|
| Rate for Payer: Healthfirst QHP |
$12.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.29
|
| Rate for Payer: SOMOS Essential |
$9.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.39
|
|
|
PR ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM
|
Professional
|
Both
|
$936.60
|
|
|
Service Code
|
HCPCS 93724 26
|
| Min. Negotiated Rate |
$175.69 |
| Max. Negotiated Rate |
$564.71 |
| Rate for Payer: Amida Care Medicaid |
$278.23
|
| Rate for Payer: Cash Price |
$252.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$250.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$238.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$250.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$238.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.24
|
| Rate for Payer: Healthfirst Commercial |
$250.98
|
| Rate for Payer: Healthfirst Essential Plan |
$564.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$238.43
|
| Rate for Payer: Healthfirst QHP |
$250.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$250.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$213.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$175.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$250.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.24
|
| Rate for Payer: SOMOS Essential |
$188.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$250.98
|
|
|
PR ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM
|
Professional
|
Both
|
$201.11
|
|
|
Service Code
|
HCPCS 93724 TC
|
| Min. Negotiated Rate |
$37.93 |
| Max. Negotiated Rate |
$278.23 |
| Rate for Payer: Amida Care Medicaid |
$278.23
|
| Rate for Payer: Cash Price |
$54.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.63
|
| Rate for Payer: Healthfirst Commercial |
$54.18
|
| Rate for Payer: Healthfirst Essential Plan |
$121.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.47
|
| Rate for Payer: Healthfirst QHP |
$54.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.63
|
| Rate for Payer: SOMOS Essential |
$40.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.18
|
|
|
PR ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM
|
Professional
|
Both
|
$1,137.71
|
|
|
Service Code
|
HCPCS 93724
|
| Min. Negotiated Rate |
$213.61 |
| Max. Negotiated Rate |
$686.61 |
| Rate for Payer: Amida Care Medicaid |
$278.23
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$305.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$274.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$274.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$289.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$305.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$289.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$305.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$305.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$228.87
|
| Rate for Payer: Healthfirst Commercial |
$305.16
|
| Rate for Payer: Healthfirst Essential Plan |
$686.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$289.90
|
| Rate for Payer: Healthfirst QHP |
$305.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$213.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$305.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$259.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$213.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$305.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$228.87
|
| Rate for Payer: SOMOS Essential |
$228.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.16
|
|
|
PR ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$163.14
|
|
|
Service Code
|
HCPCS 92270 26
|
| Min. Negotiated Rate |
$31.37 |
| Max. Negotiated Rate |
$100.84 |
| Rate for Payer: Amida Care Medicaid |
$66.32
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.62
|
| Rate for Payer: Healthfirst Commercial |
$44.82
|
| Rate for Payer: Healthfirst Essential Plan |
$100.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.58
|
| Rate for Payer: Healthfirst QHP |
$44.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.62
|
| Rate for Payer: SOMOS Essential |
$33.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.82
|
|
|
PR ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$292.99
|
|
|
Service Code
|
HCPCS 92270 TC
|
| Min. Negotiated Rate |
$64.45 |
| Max. Negotiated Rate |
$207.16 |
| Rate for Payer: Amida Care Medicaid |
$66.32
|
| Rate for Payer: Cash Price |
$90.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.05
|
| Rate for Payer: Healthfirst Commercial |
$92.07
|
| Rate for Payer: Healthfirst Essential Plan |
$207.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.47
|
| Rate for Payer: Healthfirst QHP |
$92.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.05
|
| Rate for Payer: SOMOS Essential |
$69.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.07
|
|
|
PR ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$456.09
|
|
|
Service Code
|
HCPCS 92270
|
| Min. Negotiated Rate |
$66.32 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Amida Care Medicaid |
$66.32
|
| Rate for Payer: Cash Price |
$135.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.67
|
| Rate for Payer: Healthfirst Commercial |
$136.89
|
| Rate for Payer: Healthfirst Essential Plan |
$308.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.05
|
| Rate for Payer: Healthfirst QHP |
$136.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.67
|
| Rate for Payer: SOMOS Essential |
$102.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.89
|
|
|
PR ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT
|
Professional
|
Both
|
$1,068.38
|
|
|
Service Code
|
HCPCS 93624 26
|
| Min. Negotiated Rate |
$189.75 |
| Max. Negotiated Rate |
$609.91 |
| Rate for Payer: Amida Care Medicaid |
$272.89
|
| Rate for Payer: Cash Price |
$274.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$271.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$243.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$243.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$257.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$257.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$203.30
|
| Rate for Payer: Healthfirst Commercial |
$271.07
|
| Rate for Payer: Healthfirst Essential Plan |
$609.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$257.52
|
| Rate for Payer: Healthfirst QHP |
$271.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$189.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$271.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$230.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$189.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$203.30
|
| Rate for Payer: SOMOS Essential |
$203.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$271.07
|
|
|
PR ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT
|
Professional
|
Both
|
$420.60
|
|
|
Service Code
|
HCPCS 93624 TC
|
| Min. Negotiated Rate |
$272.89 |
| Max. Negotiated Rate |
$272.89 |
| Rate for Payer: Amida Care Medicaid |
$272.89
|
|
|
PR ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT
|
Professional
|
Both
|
$1,488.97
|
|
|
Service Code
|
HCPCS 93624
|
| Min. Negotiated Rate |
$272.89 |
| Max. Negotiated Rate |
$272.89 |
| Rate for Payer: Amida Care Medicaid |
$272.89
|
|
|
PR ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL
|
Professional
|
Both
|
$4,985.61
|
|
|
Service Code
|
HCPCS 62000
|
| Min. Negotiated Rate |
$915.88 |
| Max. Negotiated Rate |
$2,943.90 |
| Rate for Payer: Cash Price |
$1,318.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,308.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,177.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,177.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,242.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,308.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,242.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,308.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,308.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$981.30
|
| Rate for Payer: Healthfirst Commercial |
$1,308.40
|
| Rate for Payer: Healthfirst Essential Plan |
$2,943.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,242.98
|
| Rate for Payer: Healthfirst QHP |
$1,308.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$915.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,308.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,112.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$915.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,308.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$981.30
|
| Rate for Payer: SOMOS Essential |
$981.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,308.40
|
|
|
PR ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL
|
Professional
|
Both
|
$6,141.21
|
|
|
Service Code
|
HCPCS 62005
|
| Min. Negotiated Rate |
$1,125.65 |
| Max. Negotiated Rate |
$3,618.16 |
| Rate for Payer: Cash Price |
$1,622.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,608.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,447.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,447.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,527.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,608.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,527.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,608.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,608.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,206.05
|
| Rate for Payer: Healthfirst Commercial |
$1,608.07
|
| Rate for Payer: Healthfirst Essential Plan |
$3,618.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,527.67
|
| Rate for Payer: Healthfirst QHP |
$1,608.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,125.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,608.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,366.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,125.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,608.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,206.05
|
| Rate for Payer: SOMOS Essential |
$1,206.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,608.07
|
|
|
PR ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN
|
Professional
|
Both
|
$7,418.15
|
|
|
Service Code
|
HCPCS 62010
|
| Min. Negotiated Rate |
$1,358.25 |
| Max. Negotiated Rate |
$4,365.81 |
| Rate for Payer: Cash Price |
$1,958.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,940.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,746.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,746.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,843.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,940.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,843.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,940.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,940.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,455.27
|
| Rate for Payer: Healthfirst Commercial |
$1,940.36
|
| Rate for Payer: Healthfirst Essential Plan |
$4,365.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,843.34
|
| Rate for Payer: Healthfirst QHP |
$1,940.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,358.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,940.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,649.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,358.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,940.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,455.27
|
| Rate for Payer: SOMOS Essential |
$1,455.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,940.36
|
|
|
PREMASOL 10 % IV SOLN
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 0338113004
|
| Hospital Charge Code |
0338113004
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.08
|
| Rate for Payer: EmblemHealth Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
|
PREMASOL 10 % IV SOLN
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 0338113004
|
| Hospital Charge Code |
0338113004
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
|
|
PR EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART
|
Professional
|
Both
|
$2,656.12
|
|
|
Service Code
|
HCPCS 34101
|
| Min. Negotiated Rate |
$486.97 |
| Max. Negotiated Rate |
$1,565.26 |
| Rate for Payer: Cash Price |
$702.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$695.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$626.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$626.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$660.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$695.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$660.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$695.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$521.75
|
| Rate for Payer: Healthfirst Commercial |
$695.67
|
| Rate for Payer: Healthfirst Essential Plan |
$1,565.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$660.89
|
| Rate for Payer: Healthfirst QHP |
$695.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$486.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$695.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$591.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$486.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$695.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$521.75
|
| Rate for Payer: SOMOS Essential |
$521.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$695.67
|
|
