|
PR ESOPHGL BALO DISTENSION DX STD W/PROVOCATION
|
Professional
|
Both
|
$2,263.70
|
|
|
Service Code
|
HCPCS 91040
|
| Min. Negotiated Rate |
$400.30 |
| Max. Negotiated Rate |
$1,286.66 |
| Rate for Payer: Cash Price |
$606.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$571.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$514.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$514.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$543.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$571.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$543.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$571.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$571.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$428.89
|
| Rate for Payer: Healthfirst Commercial |
$571.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,286.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$543.26
|
| Rate for Payer: Healthfirst QHP |
$571.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$400.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$571.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$486.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$400.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$571.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$428.89
|
| Rate for Payer: SOMOS Essential |
$428.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$571.85
|
|
|
PR ESOPHGL BALO DISTENSION DX STD W/PROVOCATION
|
Professional
|
Both
|
$199.57
|
|
|
Service Code
|
HCPCS 91040 26
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$119.34 |
| Rate for Payer: Cash Price |
$54.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.78
|
| Rate for Payer: Healthfirst Commercial |
$53.04
|
| Rate for Payer: Healthfirst Essential Plan |
$119.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.39
|
| Rate for Payer: Healthfirst QHP |
$53.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.78
|
| Rate for Payer: SOMOS Essential |
$39.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.04
|
|
|
PR ESOPHGL BALO DISTENSION DX STD W/PROVOCATION
|
Professional
|
Both
|
$2,064.09
|
|
|
Service Code
|
HCPCS 91040 TC
|
| Min. Negotiated Rate |
$363.17 |
| Max. Negotiated Rate |
$1,167.32 |
| Rate for Payer: Cash Price |
$551.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$518.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$466.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$466.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$492.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$518.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$492.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$518.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$518.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$389.11
|
| Rate for Payer: Healthfirst Commercial |
$518.81
|
| Rate for Payer: Healthfirst Essential Plan |
$1,167.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$492.87
|
| Rate for Payer: Healthfirst QHP |
$518.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$363.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$518.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$440.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$363.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$518.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$389.11
|
| Rate for Payer: SOMOS Essential |
$389.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$518.81
|
|
|
PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG
|
Professional
|
Both
|
$1,532.09
|
|
|
Service Code
|
HCPCS 91038 TC
|
| Min. Negotiated Rate |
$110.08 |
| Max. Negotiated Rate |
$870.91 |
| Rate for Payer: Amida Care Medicaid |
$110.08
|
| Rate for Payer: Cash Price |
$411.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$387.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$348.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$348.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$367.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$387.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$367.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$387.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$387.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$290.30
|
| Rate for Payer: Healthfirst Commercial |
$387.07
|
| Rate for Payer: Healthfirst Essential Plan |
$870.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$367.72
|
| Rate for Payer: Healthfirst QHP |
$387.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$387.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$329.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$387.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$290.30
|
| Rate for Payer: SOMOS Essential |
$290.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$387.07
|
|
|
PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG
|
Professional
|
Both
|
$217.70
|
|
|
Service Code
|
HCPCS 91038 26
|
| Min. Negotiated Rate |
$41.57 |
| Max. Negotiated Rate |
$133.63 |
| Rate for Payer: Amida Care Medicaid |
$110.08
|
| Rate for Payer: Cash Price |
$60.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.54
|
| Rate for Payer: Healthfirst Commercial |
$59.39
|
| Rate for Payer: Healthfirst Essential Plan |
$133.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.42
|
| Rate for Payer: Healthfirst QHP |
$59.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.54
|
| Rate for Payer: SOMOS Essential |
$44.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.39
|
|
|
PR ESOPHGL FUNCJ G-ESOP RFLX IMPD ELTRD PROLNG
|
Professional
|
Both
|
$1,749.83
|
|
|
Service Code
|
HCPCS 91038
|
| Min. Negotiated Rate |
$110.08 |
| Max. Negotiated Rate |
$1,004.51 |
| Rate for Payer: Amida Care Medicaid |
$110.08
|
| Rate for Payer: Cash Price |
$471.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$446.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$401.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$401.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$424.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$446.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$424.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$446.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$446.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$334.84
|
| Rate for Payer: Healthfirst Commercial |
$446.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,004.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$424.13
|
| Rate for Payer: Healthfirst QHP |
$446.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$312.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$446.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$379.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$312.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$446.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$334.84
|
| Rate for Payer: SOMOS Essential |
$334.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$446.45
|
|
|
PR ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG
|
Professional
|
Both
|
$228.06
|
|
|
Service Code
|
HCPCS 93616 26
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$139.23 |
| Rate for Payer: Amida Care Medicaid |
$62.27
|
| Rate for Payer: Cash Price |
$62.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.41
|
| Rate for Payer: Healthfirst Commercial |
$61.88
|
| Rate for Payer: Healthfirst Essential Plan |
$139.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.79
|
| Rate for Payer: Healthfirst QHP |
$61.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.41
|
| Rate for Payer: SOMOS Essential |
$46.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.88
|
|
|
PR ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG
|
Professional
|
Both
|
$85.19
|
|
|
Service Code
|
HCPCS 93616 TC
|
| Min. Negotiated Rate |
$62.27 |
| Max. Negotiated Rate |
$62.27 |
| Rate for Payer: Amida Care Medicaid |
$62.27
|
|
|
PR ESOPHGL REC ATRIAL W/WO VENTR ELECTRGRAMS W/PACG
|
Professional
|
Both
|
$313.25
|
|
|
Service Code
|
HCPCS 93616
|
| Min. Negotiated Rate |
$62.27 |
| Max. Negotiated Rate |
$62.27 |
| Rate for Payer: Amida Care Medicaid |
$62.27
|
|
|
PR ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS
|
Professional
|
Both
|
$65.38
|
|
|
Service Code
|
HCPCS 93615 TC
|
| Min. Negotiated Rate |
$47.86 |
| Max. Negotiated Rate |
$47.86 |
| Rate for Payer: Amida Care Medicaid |
$47.86
|
|
|
PR ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS
|
Professional
|
Both
|
$144.17
|
|
|
Service Code
|
HCPCS 93615 26
|
| Min. Negotiated Rate |
$27.02 |
| Max. Negotiated Rate |
$86.85 |
| Rate for Payer: Amida Care Medicaid |
$47.86
|
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.95
|
| Rate for Payer: Healthfirst Commercial |
$38.60
|
| Rate for Payer: Healthfirst Essential Plan |
$86.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.67
|
| Rate for Payer: Healthfirst QHP |
$38.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.95
|
| Rate for Payer: SOMOS Essential |
$28.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.60
|
|
|
PR ESOPHGL REC ATRIAL W/WO VENTRICULAR ELECTROGRAMS
|
Professional
|
Both
|
$209.55
|
|
|
Service Code
|
HCPCS 93615
|
| Min. Negotiated Rate |
$47.86 |
| Max. Negotiated Rate |
$47.86 |
| Rate for Payer: Amida Care Medicaid |
$47.86
|
|
|
PR ESPHAGOSCOPY FLEX LESION REMOVAL HOT BX FORCEPS
|
Professional
|
Both
|
$554.58
|
|
|
Service Code
|
HCPCS 43216
|
| Min. Negotiated Rate |
$105.62 |
| Max. Negotiated Rate |
$339.48 |
| Rate for Payer: Cash Price |
$151.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.16
|
| Rate for Payer: Healthfirst Commercial |
$150.88
|
| Rate for Payer: Healthfirst Essential Plan |
$339.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.34
|
| Rate for Payer: Healthfirst QHP |
$150.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.16
|
| Rate for Payer: SOMOS Essential |
$113.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.88
|
|
|
PR ESPHGOSCOPY FLEX W/BAND LIGATION ESOPHGL VARICES
|
Professional
|
Both
|
$583.59
|
|
|
Service Code
|
HCPCS 43205
|
| Min. Negotiated Rate |
$110.36 |
| Max. Negotiated Rate |
$354.71 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.24
|
| Rate for Payer: Healthfirst Commercial |
$157.65
|
| Rate for Payer: Healthfirst Essential Plan |
$354.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.77
|
| Rate for Payer: Healthfirst QHP |
$157.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$134.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.24
|
| Rate for Payer: SOMOS Essential |
$118.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.65
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL
|
Professional
|
Both
|
$13,104.21
|
|
|
Service Code
|
HCPCS 43313
|
| Min. Negotiated Rate |
$2,426.12 |
| Max. Negotiated Rate |
$7,798.25 |
| Rate for Payer: Cash Price |
$3,492.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,465.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,119.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,119.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,292.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,465.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,292.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,465.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,465.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,599.42
|
| Rate for Payer: Healthfirst Commercial |
$3,465.89
|
| Rate for Payer: Healthfirst Essential Plan |
$7,798.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,292.60
|
| Rate for Payer: Healthfirst QHP |
$3,465.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,426.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,465.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,946.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,426.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,465.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,599.42
|
| Rate for Payer: SOMOS Essential |
$2,599.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,465.89
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/RPR FSTL
|
Professional
|
Both
|
$14,062.93
|
|
|
Service Code
|
HCPCS 43314
|
| Min. Negotiated Rate |
$2,594.65 |
| Max. Negotiated Rate |
$8,339.94 |
| Rate for Payer: Cash Price |
$3,738.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,706.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,335.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,335.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,521.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,706.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,521.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,706.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,706.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,779.98
|
| Rate for Payer: Healthfirst Commercial |
$3,706.64
|
| Rate for Payer: Healthfirst Essential Plan |
$8,339.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,521.31
|
| Rate for Payer: Healthfirst QHP |
$3,706.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,594.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,706.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,150.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,594.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,706.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,779.98
|
| Rate for Payer: SOMOS Essential |
$2,779.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,706.64
|
|
|
PR ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,704.17
|
|
|
Service Code
|
HCPCS 43300
|
| Min. Negotiated Rate |
$510.17 |
| Max. Negotiated Rate |
$1,639.82 |
| Rate for Payer: Cash Price |
$735.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$728.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$655.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$655.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$692.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$728.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$692.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$728.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$728.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$546.61
|
| Rate for Payer: Healthfirst Commercial |
$728.81
|
| Rate for Payer: Healthfirst Essential Plan |
$1,639.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$692.37
|
| Rate for Payer: Healthfirst QHP |
$728.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$510.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$728.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$619.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$510.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$728.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$546.61
|
| Rate for Payer: SOMOS Essential |
$546.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$728.81
|
|
|
PR ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$4,714.01
|
|
|
Service Code
|
HCPCS 43305
|
| Min. Negotiated Rate |
$884.58 |
| Max. Negotiated Rate |
$2,843.30 |
| Rate for Payer: Cash Price |
$1,275.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,263.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,137.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,137.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,200.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,263.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,200.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,263.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,263.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$947.77
|
| Rate for Payer: Healthfirst Commercial |
$1,263.69
|
| Rate for Payer: Healthfirst Essential Plan |
$2,843.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,200.51
|
| Rate for Payer: Healthfirst QHP |
$1,263.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$884.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,263.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,074.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$884.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,263.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$947.77
|
| Rate for Payer: SOMOS Essential |
$947.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,263.69
|
|
|
PR ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$6,618.08
|
|
|
Service Code
|
HCPCS 43310
|
| Min. Negotiated Rate |
$1,219.59 |
| Max. Negotiated Rate |
$3,920.11 |
| Rate for Payer: Cash Price |
$1,759.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,742.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,568.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,568.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,655.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,742.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,655.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,742.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,742.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,306.70
|
| Rate for Payer: Healthfirst Commercial |
$1,742.27
|
| Rate for Payer: Healthfirst Essential Plan |
$3,920.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,655.16
|
| Rate for Payer: Healthfirst QHP |
$1,742.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,219.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,742.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,480.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,219.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,742.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,306.70
|
| Rate for Payer: SOMOS Essential |
$1,306.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,742.27
|
|
|
PR ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$7,083.34
|
|
|
Service Code
|
HCPCS 43312
|
| Min. Negotiated Rate |
$1,301.38 |
| Max. Negotiated Rate |
$4,183.00 |
| Rate for Payer: Cash Price |
$1,880.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,859.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,673.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,673.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,766.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,859.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,766.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,859.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,859.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,394.33
|
| Rate for Payer: Healthfirst Commercial |
$1,859.11
|
| Rate for Payer: Healthfirst Essential Plan |
$4,183.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,766.15
|
| Rate for Payer: Healthfirst QHP |
$1,859.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,301.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,859.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,580.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,301.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,859.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,394.33
|
| Rate for Payer: SOMOS Essential |
$1,394.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,859.11
|
|
|
PR ESRD RELATED SVC <FULL MONTH 12-19 YR OLD
|
Professional
|
Both
|
$68.36
|
|
|
Service Code
|
HCPCS 90969
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$41.47 |
| Rate for Payer: Amida Care Medicaid |
$7.67
|
| Rate for Payer: Cash Price |
$18.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.82
|
| Rate for Payer: Healthfirst Commercial |
$18.43
|
| Rate for Payer: Healthfirst Essential Plan |
$41.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.51
|
| Rate for Payer: Healthfirst QHP |
$18.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.82
|
| Rate for Payer: SOMOS Essential |
$13.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.43
|
|
|
PR ESRD RELATED SVC <FULL MONTH 20/>YR OLD
|
Professional
|
Both
|
$38.22
|
|
|
Service Code
|
HCPCS 90970
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$24.07 |
| Rate for Payer: Amida Care Medicaid |
$4.11
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.03
|
| Rate for Payer: Healthfirst Commercial |
$10.70
|
| Rate for Payer: Healthfirst Essential Plan |
$24.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.16
|
| Rate for Payer: Healthfirst QHP |
$10.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.03
|
| Rate for Payer: SOMOS Essential |
$8.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.70
|
|
|
PR ESRD RELATED SVC <FULL MONTH 2-11 YR OLD
|
Professional
|
Both
|
$69.62
|
|
|
Service Code
|
HCPCS 90968
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$42.23 |
| Rate for Payer: Amida Care Medicaid |
$7.85
|
| Rate for Payer: Cash Price |
$19.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.08
|
| Rate for Payer: Healthfirst Commercial |
$18.77
|
| Rate for Payer: Healthfirst Essential Plan |
$42.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.83
|
| Rate for Payer: Healthfirst QHP |
$18.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.08
|
| Rate for Payer: SOMOS Essential |
$14.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.77
|
|
|
PR ESRD RELATED SVC <FULL MONTH <2 YR OLD
|
Professional
|
Both
|
$70.88
|
|
|
Service Code
|
HCPCS 90967
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$43.02 |
| Rate for Payer: Amida Care Medicaid |
$10.15
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.34
|
| Rate for Payer: Healthfirst Commercial |
$19.12
|
| Rate for Payer: Healthfirst Essential Plan |
$43.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.16
|
| Rate for Payer: Healthfirst QHP |
$19.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.34
|
| Rate for Payer: SOMOS Essential |
$14.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.12
|
|
|
PR ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT
|
Professional
|
Both
|
$1,311.94
|
|
|
Service Code
|
HCPCS 90959
|
| Min. Negotiated Rate |
$145.32 |
| Max. Negotiated Rate |
$809.14 |
| Rate for Payer: Amida Care Medicaid |
$145.32
|
| Rate for Payer: Cash Price |
$362.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$359.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$323.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$341.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$359.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$341.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$359.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$269.71
|
| Rate for Payer: Healthfirst Commercial |
$359.62
|
| Rate for Payer: Healthfirst Essential Plan |
$809.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$341.64
|
| Rate for Payer: Healthfirst QHP |
$359.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$251.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$359.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$305.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$251.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$359.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$269.71
|
| Rate for Payer: SOMOS Essential |
$269.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$359.62
|
|
