|
PR EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK
|
Professional
|
Both
|
$1,132.88
|
|
|
Service Code
|
HCPCS 20102
|
| Min. Negotiated Rate |
$213.27 |
| Max. Negotiated Rate |
$685.51 |
| Rate for Payer: Cash Price |
$307.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$304.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$274.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$274.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$289.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$304.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$289.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$304.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$304.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$228.50
|
| Rate for Payer: Healthfirst Commercial |
$304.67
|
| Rate for Payer: Healthfirst Essential Plan |
$685.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$289.44
|
| Rate for Payer: Healthfirst QHP |
$304.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$213.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$304.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$258.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$213.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$304.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$228.50
|
| Rate for Payer: SOMOS Essential |
$228.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$304.67
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD
|
Professional
|
Both
|
$5,421.82
|
|
|
Service Code
|
HCPCS 35840
|
| Min. Negotiated Rate |
$1,008.97 |
| Max. Negotiated Rate |
$3,243.13 |
| Rate for Payer: Cash Price |
$1,448.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,441.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,297.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,297.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,369.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,441.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,369.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,441.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,441.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,081.04
|
| Rate for Payer: Healthfirst Commercial |
$1,441.39
|
| Rate for Payer: Healthfirst Essential Plan |
$3,243.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,369.32
|
| Rate for Payer: Healthfirst QHP |
$1,441.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,008.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,441.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,225.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,008.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,441.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,081.04
|
| Rate for Payer: SOMOS Essential |
$1,081.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,441.39
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ CH
|
Professional
|
Both
|
$8,911.81
|
|
|
Service Code
|
HCPCS 35820
|
| Min. Negotiated Rate |
$1,643.38 |
| Max. Negotiated Rate |
$5,282.30 |
| Rate for Payer: Cash Price |
$2,368.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,347.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,112.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,112.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,230.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,347.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,230.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,347.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,347.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,760.77
|
| Rate for Payer: Healthfirst Commercial |
$2,347.69
|
| Rate for Payer: Healthfirst Essential Plan |
$5,282.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,230.31
|
| Rate for Payer: Healthfirst QHP |
$2,347.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,643.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,347.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,995.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,643.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,347.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,760.77
|
| Rate for Payer: SOMOS Essential |
$1,760.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,347.69
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK
|
Professional
|
Both
|
$3,204.39
|
|
|
Service Code
|
HCPCS 35800
|
| Min. Negotiated Rate |
$599.89 |
| Max. Negotiated Rate |
$1,928.23 |
| Rate for Payer: Cash Price |
$860.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$856.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$771.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$771.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$814.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$856.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$814.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$856.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$856.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$642.74
|
| Rate for Payer: Healthfirst Commercial |
$856.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,928.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$814.14
|
| Rate for Payer: Healthfirst QHP |
$856.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$599.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$856.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$728.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$599.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$856.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$642.74
|
| Rate for Payer: SOMOS Essential |
$642.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$856.99
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR
|
Professional
|
Both
|
$3,733.87
|
|
|
Service Code
|
HCPCS 35860
|
| Min. Negotiated Rate |
$690.38 |
| Max. Negotiated Rate |
$2,219.09 |
| Rate for Payer: Cash Price |
$993.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$986.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$887.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$887.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$936.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$986.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$936.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$986.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$986.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$739.70
|
| Rate for Payer: Healthfirst Commercial |
$986.26
|
| Rate for Payer: Healthfirst Essential Plan |
$2,219.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$936.95
|
| Rate for Payer: Healthfirst QHP |
$986.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$690.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$986.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$838.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$690.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$986.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$739.70
|
| Rate for Payer: SOMOS Essential |
$739.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$986.26
|
|
|
PR EXPL RETROPERITONEUM W/WO BX SPX
|
Professional
|
Both
|
$4,125.14
|
|
|
Service Code
|
HCPCS 49010
|
| Min. Negotiated Rate |
$768.42 |
| Max. Negotiated Rate |
$2,469.94 |
| Rate for Payer: Cash Price |
$1,101.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,097.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$987.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$987.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,042.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,097.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,042.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,097.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,097.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$823.31
|
| Rate for Payer: Healthfirst Commercial |
$1,097.75
|
| Rate for Payer: Healthfirst Essential Plan |
$2,469.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,042.86
|
| Rate for Payer: Healthfirst QHP |
$1,097.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$768.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,097.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$933.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$768.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,097.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$823.31
|
| Rate for Payer: SOMOS Essential |
$823.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,097.75
|
|
|
PR EXPL RPR & PRESACRAL DRG RECTAL INJURY
|
Professional
|
Both
|
$5,012.07
|
|
|
Service Code
|
HCPCS 45562
|
| Min. Negotiated Rate |
$980.08 |
| Max. Negotiated Rate |
$3,150.27 |
| Rate for Payer: Cash Price |
$1,408.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,400.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,260.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,260.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,330.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,400.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,330.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,400.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,400.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,050.09
|
| Rate for Payer: Healthfirst Commercial |
$1,400.12
|
| Rate for Payer: Healthfirst Essential Plan |
$3,150.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,330.11
|
| Rate for Payer: Healthfirst QHP |
$1,400.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$980.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,400.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,190.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$980.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,400.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,050.09
|
| Rate for Payer: SOMOS Essential |
$1,050.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,400.12
|
|
|
PR EXPL RPR & PRESACRAL DRG RECTAL INJ W/COLOSTOMY
|
Professional
|
Both
|
$7,493.01
|
|
|
Service Code
|
HCPCS 45563
|
| Min. Negotiated Rate |
$1,385.01 |
| Max. Negotiated Rate |
$4,451.83 |
| Rate for Payer: Cash Price |
$1,993.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,978.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,780.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,780.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,879.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,978.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,879.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,978.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,978.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,483.94
|
| Rate for Payer: Healthfirst Commercial |
$1,978.59
|
| Rate for Payer: Healthfirst Essential Plan |
$4,451.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,879.66
|
| Rate for Payer: Healthfirst QHP |
$1,978.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,385.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,978.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,681.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,385.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,978.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,483.94
|
| Rate for Payer: SOMOS Essential |
$1,483.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,978.59
|
|
|
PR EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL
|
Professional
|
Both
|
$2,885.44
|
|
|
Service Code
|
HCPCS 54560
|
| Min. Negotiated Rate |
$549.12 |
| Max. Negotiated Rate |
$1,765.04 |
| Rate for Payer: Cash Price |
$789.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$784.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$706.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$706.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$745.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$784.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$745.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$784.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$784.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$588.35
|
| Rate for Payer: Healthfirst Commercial |
$784.46
|
| Rate for Payer: Healthfirst Essential Plan |
$1,765.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$745.24
|
| Rate for Payer: Healthfirst QHP |
$784.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$549.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$784.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$666.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$549.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$784.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$588.35
|
| Rate for Payer: SOMOS Essential |
$588.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$784.46
|
|
|
PR EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA
|
Professional
|
Both
|
$2,065.84
|
|
|
Service Code
|
HCPCS 54550
|
| Min. Negotiated Rate |
$394.48 |
| Max. Negotiated Rate |
$1,267.96 |
| Rate for Payer: Cash Price |
$567.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$563.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$507.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$507.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$535.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$563.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$535.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$563.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$563.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$422.65
|
| Rate for Payer: Healthfirst Commercial |
$563.54
|
| Rate for Payer: Healthfirst Essential Plan |
$1,267.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$535.36
|
| Rate for Payer: Healthfirst QHP |
$563.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$394.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$563.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$479.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$394.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$563.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$422.65
|
| Rate for Payer: SOMOS Essential |
$422.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$563.54
|
|
|
PR EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST
|
Professional
|
Both
|
$1,850.66
|
|
|
Service Code
|
HCPCS 25248
|
| Min. Negotiated Rate |
$351.66 |
| Max. Negotiated Rate |
$1,130.33 |
| Rate for Payer: Cash Price |
$514.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$502.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$452.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$452.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$477.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$502.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$477.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$502.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$502.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$376.78
|
| Rate for Payer: Healthfirst Commercial |
$502.37
|
| Rate for Payer: Healthfirst Essential Plan |
$1,130.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$477.25
|
| Rate for Payer: Healthfirst QHP |
$502.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$351.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$502.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$427.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$351.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$502.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$376.78
|
| Rate for Payer: SOMOS Essential |
$376.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$502.37
|
|
|
PR EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST
|
Professional
|
Both
|
$3,662.40
|
|
|
Service Code
|
HCPCS 55860
|
| Min. Negotiated Rate |
$695.30 |
| Max. Negotiated Rate |
$2,234.88 |
| Rate for Payer: Cash Price |
$999.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$993.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$893.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$893.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$943.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$993.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$943.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$993.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$993.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$744.96
|
| Rate for Payer: Healthfirst Commercial |
$993.28
|
| Rate for Payer: Healthfirst Essential Plan |
$2,234.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$943.62
|
| Rate for Payer: Healthfirst QHP |
$993.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$695.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$993.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$844.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$695.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$993.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$744.96
|
| Rate for Payer: SOMOS Essential |
$744.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$993.28
|
|
|
PR EXPOS PROSTATE INSJ RADIOAC SBST W/BI PELV LYMPH
|
Professional
|
Both
|
$5,562.62
|
|
|
Service Code
|
HCPCS 55865
|
| Min. Negotiated Rate |
$1,057.81 |
| Max. Negotiated Rate |
$3,400.11 |
| Rate for Payer: Cash Price |
$1,519.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,511.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,360.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,360.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,435.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,511.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,435.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,511.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,511.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,133.37
|
| Rate for Payer: Healthfirst Commercial |
$1,511.16
|
| Rate for Payer: Healthfirst Essential Plan |
$3,400.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,435.60
|
| Rate for Payer: Healthfirst QHP |
$1,511.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,057.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,511.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,284.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,057.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,511.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,133.37
|
| Rate for Payer: SOMOS Essential |
$1,133.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,511.16
|
|
|
PR EXPOS PROSTATE INSJ RADIOACT SBST W/LYMPH BX
|
Professional
|
Both
|
$4,576.85
|
|
|
Service Code
|
HCPCS 55862
|
| Min. Negotiated Rate |
$868.48 |
| Max. Negotiated Rate |
$2,791.55 |
| Rate for Payer: Cash Price |
$1,248.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,240.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,116.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,116.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,178.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,240.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,178.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,240.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,240.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$930.52
|
| Rate for Payer: Healthfirst Commercial |
$1,240.69
|
| Rate for Payer: Healthfirst Essential Plan |
$2,791.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,178.66
|
| Rate for Payer: Healthfirst QHP |
$1,240.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$868.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,240.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,054.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$868.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,240.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$930.52
|
| Rate for Payer: SOMOS Essential |
$930.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,240.69
|
|
|
PR EXPRESSION CONJUNCTIVAL FOLLICLES
|
Professional
|
Both
|
$189.28
|
|
|
Service Code
|
HCPCS 68040
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$118.60 |
| Rate for Payer: Cash Price |
$52.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.53
|
| Rate for Payer: Healthfirst Commercial |
$52.71
|
| Rate for Payer: Healthfirst Essential Plan |
$118.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.07
|
| Rate for Payer: Healthfirst QHP |
$52.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.53
|
| Rate for Payer: SOMOS Essential |
$39.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.71
|
|
|
PR EXTENDED VISUAL FIELD XM UNI/BI I&R
|
Professional
|
Both
|
$105.60
|
|
|
Service Code
|
HCPCS 92083 26
|
| Min. Negotiated Rate |
$20.10 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Amida Care Medicaid |
$59.12
|
| Rate for Payer: Cash Price |
$29.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.53
|
| Rate for Payer: Healthfirst Commercial |
$28.71
|
| Rate for Payer: Healthfirst Essential Plan |
$64.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.27
|
| Rate for Payer: Healthfirst QHP |
$28.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.53
|
| Rate for Payer: SOMOS Essential |
$21.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.71
|
|
|
PR EXTENDED VISUAL FIELD XM UNI/BI I&R
|
Professional
|
Both
|
$155.12
|
|
|
Service Code
|
HCPCS 92083 TC
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$96.59 |
| Rate for Payer: Amida Care Medicaid |
$59.12
|
| Rate for Payer: Cash Price |
$43.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.20
|
| Rate for Payer: Healthfirst Commercial |
$42.93
|
| Rate for Payer: Healthfirst Essential Plan |
$96.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.78
|
| Rate for Payer: Healthfirst QHP |
$42.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.20
|
| Rate for Payer: SOMOS Essential |
$32.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.93
|
|
|
PR EXTENDED VISUAL FIELD XM UNI/BI I&R
|
Professional
|
Both
|
$260.72
|
|
|
Service Code
|
HCPCS 92083
|
| Min. Negotiated Rate |
$50.15 |
| Max. Negotiated Rate |
$161.19 |
| Rate for Payer: Amida Care Medicaid |
$59.12
|
| Rate for Payer: Cash Price |
$72.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.73
|
| Rate for Payer: Healthfirst Commercial |
$71.64
|
| Rate for Payer: Healthfirst Essential Plan |
$161.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.06
|
| Rate for Payer: Healthfirst QHP |
$71.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.73
|
| Rate for Payer: SOMOS Essential |
$53.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.64
|
|
|
PR EXTENSIVE RETINOPATHY 1/> SESS PRETERM INFANT
|
Professional
|
Both
|
$4,743.94
|
|
|
Service Code
|
HCPCS 67229
|
| Min. Negotiated Rate |
$900.42 |
| Max. Negotiated Rate |
$2,894.20 |
| Rate for Payer: Cash Price |
$1,304.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,286.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,157.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,157.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,221.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,286.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,221.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,286.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,286.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$964.73
|
| Rate for Payer: Healthfirst Commercial |
$1,286.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,894.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,221.99
|
| Rate for Payer: Healthfirst QHP |
$1,286.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$900.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,286.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,093.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$900.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,286.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$964.73
|
| Rate for Payer: SOMOS Essential |
$964.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,286.31
|
|
|
PR EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS
|
Professional
|
Both
|
$475.90
|
|
|
Service Code
|
HCPCS 59412
|
| Min. Negotiated Rate |
$87.10 |
| Max. Negotiated Rate |
$279.97 |
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.32
|
| Rate for Payer: Healthfirst Commercial |
$124.43
|
| Rate for Payer: Healthfirst Essential Plan |
$279.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.21
|
| Rate for Payer: Healthfirst QHP |
$124.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.32
|
| Rate for Payer: SOMOS Essential |
$93.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.43
|
|
|
PR EXTERNAL DRAINAGE PSEUDOCYST OF PANCREAS OPEN
|
Professional
|
Both
|
$4,963.88
|
|
|
Service Code
|
HCPCS 48510
|
| Min. Negotiated Rate |
$918.85 |
| Max. Negotiated Rate |
$2,953.44 |
| Rate for Payer: Cash Price |
$1,322.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,312.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,181.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,181.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,247.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,312.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,247.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,312.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,312.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$984.48
|
| Rate for Payer: Healthfirst Commercial |
$1,312.64
|
| Rate for Payer: Healthfirst Essential Plan |
$2,953.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,247.01
|
| Rate for Payer: Healthfirst QHP |
$1,312.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$918.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,312.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,115.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$918.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,312.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$984.48
|
| Rate for Payer: SOMOS Essential |
$984.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,312.64
|
|
|
PR EXTERNAL ECG REC>48HR<7D RECORDING
|
Professional
|
Both
|
$53.06
|
|
|
Service Code
|
HCPCS 93242
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$31.09 |
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.37
|
| Rate for Payer: Healthfirst Commercial |
$13.82
|
| Rate for Payer: Healthfirst Essential Plan |
$31.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.13
|
| Rate for Payer: Healthfirst QHP |
$13.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.37
|
| Rate for Payer: SOMOS Essential |
$10.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.82
|
|
|
PR EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION
|
Professional
|
Both
|
$92.54
|
|
|
Service Code
|
HCPCS 93244
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$55.51 |
| Rate for Payer: Amida Care Medicaid |
$12.56
|
| Rate for Payer: Cash Price |
$24.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.50
|
| Rate for Payer: Healthfirst Commercial |
$24.67
|
| Rate for Payer: Healthfirst Essential Plan |
$55.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.44
|
| Rate for Payer: Healthfirst QHP |
$24.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.50
|
| Rate for Payer: SOMOS Essential |
$18.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.67
|
|
|
PR EXTERNAL ECG REC>48HR<7D SCAN ALYS REPORT R&I
|
Professional
|
Both
|
$1,130.12
|
|
|
Service Code
|
HCPCS 93241
|
| Min. Negotiated Rate |
$217.30 |
| Max. Negotiated Rate |
$698.47 |
| Rate for Payer: Cash Price |
$303.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$310.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$310.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$310.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.82
|
| Rate for Payer: Healthfirst Commercial |
$310.43
|
| Rate for Payer: Healthfirst Essential Plan |
$698.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$294.91
|
| Rate for Payer: Healthfirst QHP |
$310.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$217.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$310.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$263.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$217.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$310.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$232.82
|
| Rate for Payer: SOMOS Essential |
$232.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$310.43
|
|
|
PR EXTERNAL ECG REC>48HR<7D SCANNING ALYS W/REPORT
|
Professional
|
Both
|
$984.55
|
|
|
Service Code
|
HCPCS 93243
|
| Min. Negotiated Rate |
$190.36 |
| Max. Negotiated Rate |
$611.87 |
| Rate for Payer: Cash Price |
$263.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$271.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$244.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$258.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$258.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$203.96
|
| Rate for Payer: Healthfirst Commercial |
$271.94
|
| Rate for Payer: Healthfirst Essential Plan |
$611.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$258.34
|
| Rate for Payer: Healthfirst QHP |
$271.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$190.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$271.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$231.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$190.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$203.96
|
| Rate for Payer: SOMOS Essential |
$203.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$271.94
|
|
