|
PR EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART
|
Professional
|
Both
|
$4,071.06
|
|
|
Service Code
|
HCPCS 34001
|
| Min. Negotiated Rate |
$747.36 |
| Max. Negotiated Rate |
$2,402.21 |
| Rate for Payer: Cash Price |
$1,078.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,067.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$960.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$960.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,014.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,067.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,014.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,067.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,067.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$800.74
|
| Rate for Payer: Healthfirst Commercial |
$1,067.65
|
| Rate for Payer: Healthfirst Essential Plan |
$2,402.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,014.27
|
| Rate for Payer: Healthfirst QHP |
$1,067.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$747.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,067.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$907.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$747.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,067.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$800.74
|
| Rate for Payer: SOMOS Essential |
$800.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,067.65
|
|
|
PR EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART
|
Professional
|
Both
|
$4,539.33
|
|
|
Service Code
|
HCPCS 34201
|
| Min. Negotiated Rate |
$831.02 |
| Max. Negotiated Rate |
$2,671.13 |
| Rate for Payer: Cash Price |
$1,202.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,187.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,068.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,068.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,127.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,187.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,127.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,187.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,187.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$890.38
|
| Rate for Payer: Healthfirst Commercial |
$1,187.17
|
| Rate for Payer: Healthfirst Essential Plan |
$2,671.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,127.81
|
| Rate for Payer: Healthfirst QHP |
$1,187.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$831.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,187.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,009.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$831.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,187.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$890.38
|
| Rate for Payer: SOMOS Essential |
$890.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,187.17
|
|
|
PR EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$4,379.38
|
|
|
Service Code
|
HCPCS 34051
|
| Min. Negotiated Rate |
$810.83 |
| Max. Negotiated Rate |
$2,606.24 |
| Rate for Payer: Cash Price |
$1,167.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,158.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,042.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,042.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,100.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,158.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,100.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,158.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,158.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$868.75
|
| Rate for Payer: Healthfirst Commercial |
$1,158.33
|
| Rate for Payer: Healthfirst Essential Plan |
$2,606.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,100.41
|
| Rate for Payer: Healthfirst QHP |
$1,158.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$810.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,158.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$984.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$810.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,158.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$868.75
|
| Rate for Payer: SOMOS Essential |
$868.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,158.33
|
|
|
PR EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC
|
Professional
|
Both
|
$4,211.03
|
|
|
Service Code
|
HCPCS 34203
|
| Min. Negotiated Rate |
$773.34 |
| Max. Negotiated Rate |
$2,485.73 |
| Rate for Payer: Cash Price |
$1,116.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,104.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$994.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$994.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,049.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,104.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,049.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,104.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,104.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$828.58
|
| Rate for Payer: Healthfirst Commercial |
$1,104.77
|
| Rate for Payer: Healthfirst Essential Plan |
$2,485.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,049.53
|
| Rate for Payer: Healthfirst QHP |
$1,104.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$773.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,104.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$939.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$773.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,104.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$828.58
|
| Rate for Payer: SOMOS Essential |
$828.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,104.77
|
|
|
PR EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART
|
Professional
|
Both
|
$6,179.15
|
|
|
Service Code
|
HCPCS 34151
|
| Min. Negotiated Rate |
$1,134.00 |
| Max. Negotiated Rate |
$3,645.00 |
| Rate for Payer: Cash Price |
$1,637.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,620.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,458.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,458.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,539.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,620.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,539.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,620.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,620.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,215.00
|
| Rate for Payer: Healthfirst Commercial |
$1,620.00
|
| Rate for Payer: Healthfirst Essential Plan |
$3,645.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,539.00
|
| Rate for Payer: Healthfirst QHP |
$1,620.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,134.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,620.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,377.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,134.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,620.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,215.00
|
| Rate for Payer: SOMOS Essential |
$1,215.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,620.00
|
|
|
PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$2,662.14
|
|
|
Service Code
|
HCPCS 34111
|
| Min. Negotiated Rate |
$485.88 |
| Max. Negotiated Rate |
$1,561.77 |
| Rate for Payer: Cash Price |
$701.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$694.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$624.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$624.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$659.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$694.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$659.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$694.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$694.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$520.59
|
| Rate for Payer: Healthfirst Commercial |
$694.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,561.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$659.41
|
| Rate for Payer: Healthfirst QHP |
$694.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$485.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$694.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$590.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$485.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$694.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$520.59
|
| Rate for Payer: SOMOS Essential |
$520.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$694.12
|
|
|
PR EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$729.47
|
|
|
Service Code
|
HCPCS 99285
|
| Min. Negotiated Rate |
$67.19 |
| Max. Negotiated Rate |
$438.84 |
| Rate for Payer: Amida Care Medicaid |
$67.19
|
| Rate for Payer: Cash Price |
$196.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$195.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$175.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$195.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.28
|
| Rate for Payer: Healthfirst Commercial |
$195.04
|
| Rate for Payer: Healthfirst Essential Plan |
$438.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.29
|
| Rate for Payer: Healthfirst QHP |
$195.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$195.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$165.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$195.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.28
|
| Rate for Payer: SOMOS Essential |
$146.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.04
|
|
|
PR EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$299.95
|
|
|
Service Code
|
HCPCS 99283
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$176.83 |
| Rate for Payer: Amida Care Medicaid |
$24.41
|
| Rate for Payer: Cash Price |
$79.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$78.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.94
|
| Rate for Payer: Healthfirst Commercial |
$78.59
|
| Rate for Payer: Healthfirst Essential Plan |
$176.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.66
|
| Rate for Payer: Healthfirst QHP |
$78.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.94
|
| Rate for Payer: SOMOS Essential |
$58.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.59
|
|
|
PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$50.89
|
|
|
Service Code
|
HCPCS 99281
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Amida Care Medicaid |
$8.04
|
| Rate for Payer: Cash Price |
$12.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.60
|
| Rate for Payer: Healthfirst Commercial |
$12.80
|
| Rate for Payer: Healthfirst Essential Plan |
$28.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.16
|
| Rate for Payer: Healthfirst QHP |
$12.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.60
|
| Rate for Payer: SOMOS Essential |
$9.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.80
|
|
|
PR EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
HCPCS 99284
|
| Min. Negotiated Rate |
$45.02 |
| Max. Negotiated Rate |
$302.49 |
| Rate for Payer: Amida Care Medicaid |
$45.02
|
| Rate for Payer: Cash Price |
$135.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.83
|
| Rate for Payer: Healthfirst Commercial |
$134.44
|
| Rate for Payer: Healthfirst Essential Plan |
$302.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.72
|
| Rate for Payer: Healthfirst QHP |
$134.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.83
|
| Rate for Payer: SOMOS Essential |
$100.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.44
|
|
|
PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$174.02
|
|
|
Service Code
|
HCPCS 99282
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$105.21 |
| Rate for Payer: Amida Care Medicaid |
$15.11
|
| Rate for Payer: Cash Price |
$46.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.07
|
| Rate for Payer: Healthfirst Commercial |
$46.76
|
| Rate for Payer: Healthfirst Essential Plan |
$105.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.42
|
| Rate for Payer: Healthfirst QHP |
$46.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.07
|
| Rate for Payer: SOMOS Essential |
$35.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.76
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$151.90
|
|
|
Service Code
|
HCPCS 51784 26
|
| Min. Negotiated Rate |
$28.29 |
| Max. Negotiated Rate |
$90.92 |
| Rate for Payer: Cash Price |
$41.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.31
|
| Rate for Payer: Healthfirst Commercial |
$40.41
|
| Rate for Payer: Healthfirst Essential Plan |
$90.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.39
|
| Rate for Payer: Healthfirst QHP |
$40.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.31
|
| Rate for Payer: SOMOS Essential |
$30.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.41
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$271.08
|
|
|
Service Code
|
HCPCS 51784
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$163.94 |
| Rate for Payer: Cash Price |
$74.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.65
|
| Rate for Payer: Healthfirst Commercial |
$72.86
|
| Rate for Payer: Healthfirst Essential Plan |
$163.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.22
|
| Rate for Payer: Healthfirst QHP |
$72.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.65
|
| Rate for Payer: SOMOS Essential |
$54.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.86
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$119.18
|
|
|
Service Code
|
HCPCS 51784 TC
|
| Min. Negotiated Rate |
$22.71 |
| Max. Negotiated Rate |
$73.01 |
| Rate for Payer: Cash Price |
$33.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.34
|
| Rate for Payer: Healthfirst Commercial |
$32.45
|
| Rate for Payer: Healthfirst Essential Plan |
$73.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.83
|
| Rate for Payer: Healthfirst QHP |
$32.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.34
|
| Rate for Payer: SOMOS Essential |
$24.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.45
|
|
|
PRENATAL 27-0.8 MG PO TABS
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 0904531360
|
| Hospital Charge Code |
0904531360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
|
PRENATAL 27-0.8 MG PO TABS
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 0904531360
|
| Hospital Charge Code |
0904531360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: EmblemHealth Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
PRENATAL (W/IRON & FA) 27-0.8 MG PO TABS
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 4329255515
|
| Hospital Charge Code |
4329255515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: EmblemHealth Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
PRENATAL (W/IRON & FA) 27-0.8 MG PO TABS
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
NDC 4329255515
|
| Hospital Charge Code |
4329255515
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$475.58
|
|
|
Service Code
|
HCPCS 57505
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$286.88 |
| Rate for Payer: Cash Price |
$129.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.62
|
| Rate for Payer: Healthfirst Commercial |
$127.50
|
| Rate for Payer: Healthfirst Essential Plan |
$286.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.12
|
| Rate for Payer: Healthfirst QHP |
$127.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.62
|
| Rate for Payer: SOMOS Essential |
$95.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.50
|
|
|
PR ENDOLUMINAL BX BILIARY TREE PRQ ANY METH 1/MLT
|
Professional
|
Both
|
$584.33
|
|
|
Service Code
|
HCPCS 47543
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$349.72 |
| Rate for Payer: Cash Price |
$157.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$155.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.57
|
| Rate for Payer: Healthfirst Commercial |
$155.43
|
| Rate for Payer: Healthfirst Essential Plan |
$349.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.66
|
| Rate for Payer: Healthfirst QHP |
$155.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.57
|
| Rate for Payer: SOMOS Essential |
$116.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.43
|
|
|
PR ENDOLUMINAL BX URTR &/RNL PELVIS NONENDOSCOPIC
|
Professional
|
Both
|
$573.20
|
|
|
Service Code
|
HCPCS 50606
|
| Min. Negotiated Rate |
$108.29 |
| Max. Negotiated Rate |
$348.07 |
| Rate for Payer: Cash Price |
$154.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.03
|
| Rate for Payer: Healthfirst Commercial |
$154.70
|
| Rate for Payer: Healthfirst Essential Plan |
$348.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.97
|
| Rate for Payer: Healthfirst QHP |
$154.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.03
|
| Rate for Payer: SOMOS Essential |
$116.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.70
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL
|
Professional
|
Both
|
$789.36
|
|
|
Service Code
|
HCPCS 92979
|
| Min. Negotiated Rate |
$134.92 |
| Max. Negotiated Rate |
$134.92 |
| Rate for Payer: Amida Care Medicaid |
$134.92
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL
|
Professional
|
Both
|
$465.99
|
|
|
Service Code
|
HCPCS 92979 TC
|
| Min. Negotiated Rate |
$134.92 |
| Max. Negotiated Rate |
$134.92 |
| Rate for Payer: Amida Care Medicaid |
$134.92
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL
|
Professional
|
Both
|
$323.37
|
|
|
Service Code
|
HCPCS 92979 26
|
| Min. Negotiated Rate |
$59.99 |
| Max. Negotiated Rate |
$192.82 |
| Rate for Payer: Amida Care Medicaid |
$134.92
|
| Rate for Payer: Cash Price |
$85.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.28
|
| Rate for Payer: Healthfirst Commercial |
$85.70
|
| Rate for Payer: Healthfirst Essential Plan |
$192.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.42
|
| Rate for Payer: Healthfirst QHP |
$85.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.28
|
| Rate for Payer: SOMOS Essential |
$64.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.70
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL
|
Professional
|
Both
|
$407.61
|
|
|
Service Code
|
HCPCS 92978 26
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$241.83 |
| Rate for Payer: Amida Care Medicaid |
$223.28
|
| Rate for Payer: Cash Price |
$108.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.61
|
| Rate for Payer: Healthfirst Commercial |
$107.48
|
| Rate for Payer: Healthfirst Essential Plan |
$241.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.11
|
| Rate for Payer: Healthfirst QHP |
$107.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.61
|
| Rate for Payer: SOMOS Essential |
$80.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.48
|
|
