|
PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 SQ CM/<
|
Professional
|
Both
|
$2,920.54
|
|
|
Service Code
|
HCPCS 15200
|
| Min. Negotiated Rate |
$551.22 |
| Max. Negotiated Rate |
$1,771.76 |
| Rate for Payer: Cash Price |
$793.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$787.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$708.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$708.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$748.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$787.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$748.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$787.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$787.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$590.59
|
| Rate for Payer: Healthfirst Commercial |
$787.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,771.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$748.08
|
| Rate for Payer: Healthfirst QHP |
$787.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$551.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$787.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$669.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$551.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$787.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$590.59
|
| Rate for Payer: SOMOS Essential |
$590.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$787.45
|
|
|
PR FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 SQ CM/<
|
Professional
|
Both
|
$297.22
|
|
|
Service Code
|
HCPCS 15221
|
| Min. Negotiated Rate |
$55.71 |
| Max. Negotiated Rate |
$179.08 |
| Rate for Payer: Cash Price |
$80.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.69
|
| Rate for Payer: Healthfirst Commercial |
$79.59
|
| Rate for Payer: Healthfirst Essential Plan |
$179.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.61
|
| Rate for Payer: Healthfirst QHP |
$79.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.69
|
| Rate for Payer: SOMOS Essential |
$59.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.59
|
|
|
PR FTH/GFT FR W/DIR CLSR TRNK EA ADDL 20 SQ CM
|
Professional
|
Both
|
$334.36
|
|
|
Service Code
|
HCPCS 15201
|
| Min. Negotiated Rate |
$61.94 |
| Max. Negotiated Rate |
$199.10 |
| Rate for Payer: Cash Price |
$89.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$88.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.37
|
| Rate for Payer: Healthfirst Commercial |
$88.49
|
| Rate for Payer: Healthfirst Essential Plan |
$199.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.07
|
| Rate for Payer: Healthfirst QHP |
$88.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.37
|
| Rate for Payer: SOMOS Essential |
$66.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.49
|
|
|
PR FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA ADDL
|
Professional
|
Both
|
$451.75
|
|
|
Service Code
|
HCPCS 15241
|
| Min. Negotiated Rate |
$85.66 |
| Max. Negotiated Rate |
$275.33 |
| Rate for Payer: Cash Price |
$123.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.78
|
| Rate for Payer: Healthfirst Commercial |
$122.37
|
| Rate for Payer: Healthfirst Essential Plan |
$275.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.25
|
| Rate for Payer: Healthfirst QHP |
$122.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.78
|
| Rate for Payer: SOMOS Essential |
$91.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.37
|
|
|
PR FULL FIELD ELECTRORETINOGRAPHY W/I&R
|
Professional
|
Both
|
$534.52
|
|
|
Service Code
|
HCPCS 92273
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$317.93 |
| Rate for Payer: Amida Care Medicaid |
$87.63
|
| Rate for Payer: Cash Price |
$146.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.97
|
| Rate for Payer: Healthfirst Commercial |
$141.30
|
| Rate for Payer: Healthfirst Essential Plan |
$317.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.24
|
| Rate for Payer: Healthfirst QHP |
$141.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$120.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.97
|
| Rate for Payer: SOMOS Essential |
$105.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.30
|
|
|
PR FULL FIELD ELECTRORETINOGRAPHY W/I&R
|
Professional
|
Both
|
$392.18
|
|
|
Service Code
|
HCPCS 92273 TC
|
| Min. Negotiated Rate |
$72.32 |
| Max. Negotiated Rate |
$232.47 |
| Rate for Payer: Amida Care Medicaid |
$87.63
|
| Rate for Payer: Cash Price |
$107.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$92.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.49
|
| Rate for Payer: Healthfirst Commercial |
$103.32
|
| Rate for Payer: Healthfirst Essential Plan |
$232.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.15
|
| Rate for Payer: Healthfirst QHP |
$103.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$87.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.49
|
| Rate for Payer: SOMOS Essential |
$77.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.32
|
|
|
PR FULL FIELD ELECTRORETINOGRAPHY W/I&R
|
Professional
|
Both
|
$142.35
|
|
|
Service Code
|
HCPCS 92273 26
|
| Min. Negotiated Rate |
$26.58 |
| Max. Negotiated Rate |
$87.63 |
| Rate for Payer: Amida Care Medicaid |
$87.63
|
| Rate for Payer: Cash Price |
$38.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.48
|
| Rate for Payer: Healthfirst Commercial |
$37.97
|
| Rate for Payer: Healthfirst Essential Plan |
$85.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.07
|
| Rate for Payer: Healthfirst QHP |
$37.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.48
|
| Rate for Payer: SOMOS Essential |
$28.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.97
|
|
|
PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR
|
Professional
|
Both
|
$1,133.13
|
|
|
Service Code
|
HCPCS 95962
|
| Min. Negotiated Rate |
$169.97 |
| Max. Negotiated Rate |
$720.59 |
| Rate for Payer: Amida Care Medicaid |
$169.97
|
| Rate for Payer: Cash Price |
$319.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$320.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$288.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$288.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$320.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$320.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$320.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$240.19
|
| Rate for Payer: Healthfirst Commercial |
$320.26
|
| Rate for Payer: Healthfirst Essential Plan |
$720.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$304.25
|
| Rate for Payer: Healthfirst QHP |
$320.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$224.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$320.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$272.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$224.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$320.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$240.19
|
| Rate for Payer: SOMOS Essential |
$240.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$320.26
|
|
|
PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR
|
Professional
|
Both
|
$439.60
|
|
|
Service Code
|
HCPCS 95962 TC
|
| Min. Negotiated Rate |
$91.07 |
| Max. Negotiated Rate |
$292.73 |
| Rate for Payer: Amida Care Medicaid |
$169.97
|
| Rate for Payer: Cash Price |
$129.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.58
|
| Rate for Payer: Healthfirst Commercial |
$130.10
|
| Rate for Payer: Healthfirst Essential Plan |
$292.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$123.59
|
| Rate for Payer: Healthfirst QHP |
$130.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.58
|
| Rate for Payer: SOMOS Essential |
$97.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.10
|
|
|
PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND ADDL HR
|
Professional
|
Both
|
$693.53
|
|
|
Service Code
|
HCPCS 95962 26
|
| Min. Negotiated Rate |
$133.10 |
| Max. Negotiated Rate |
$427.84 |
| Rate for Payer: Amida Care Medicaid |
$169.97
|
| Rate for Payer: Cash Price |
$190.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$190.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$171.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$171.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$190.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.61
|
| Rate for Payer: Healthfirst Commercial |
$190.15
|
| Rate for Payer: Healthfirst Essential Plan |
$427.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$180.64
|
| Rate for Payer: Healthfirst QHP |
$190.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$190.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$190.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.61
|
| Rate for Payer: SOMOS Essential |
$142.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$190.15
|
|
|
PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR
|
Professional
|
Both
|
$1,325.07
|
|
|
Service Code
|
HCPCS 95961
|
| Min. Negotiated Rate |
$180.49 |
| Max. Negotiated Rate |
$845.37 |
| Rate for Payer: Amida Care Medicaid |
$180.49
|
| Rate for Payer: Cash Price |
$381.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$375.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$338.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$338.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$356.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$375.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$356.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$375.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$281.79
|
| Rate for Payer: Healthfirst Commercial |
$375.72
|
| Rate for Payer: Healthfirst Essential Plan |
$845.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$356.93
|
| Rate for Payer: Healthfirst QHP |
$375.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$263.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$375.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$319.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$263.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$375.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$281.79
|
| Rate for Payer: SOMOS Essential |
$281.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$375.72
|
|
|
PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR
|
Professional
|
Both
|
$666.72
|
|
|
Service Code
|
HCPCS 95961 TC
|
| Min. Negotiated Rate |
$138.62 |
| Max. Negotiated Rate |
$445.57 |
| Rate for Payer: Amida Care Medicaid |
$180.49
|
| Rate for Payer: Cash Price |
$200.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$198.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$178.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$178.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$188.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$198.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$188.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.52
|
| Rate for Payer: Healthfirst Commercial |
$198.03
|
| Rate for Payer: Healthfirst Essential Plan |
$445.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$188.13
|
| Rate for Payer: Healthfirst QHP |
$198.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$168.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$198.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$148.52
|
| Rate for Payer: SOMOS Essential |
$148.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$198.03
|
|
|
PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR
|
Professional
|
Both
|
$658.35
|
|
|
Service Code
|
HCPCS 95961 26
|
| Min. Negotiated Rate |
$124.38 |
| Max. Negotiated Rate |
$399.80 |
| Rate for Payer: Amida Care Medicaid |
$180.49
|
| Rate for Payer: Cash Price |
$181.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$177.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$159.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$159.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$168.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$177.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$168.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.27
|
| Rate for Payer: Healthfirst Commercial |
$177.69
|
| Rate for Payer: Healthfirst Essential Plan |
$399.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$168.81
|
| Rate for Payer: Healthfirst QHP |
$177.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$124.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$177.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$151.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$124.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$177.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$133.27
|
| Rate for Payer: SOMOS Essential |
$133.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$177.69
|
|
|
PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$83.02
|
|
|
Service Code
|
HCPCS 92250 26
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$55.79 |
| Rate for Payer: Amida Care Medicaid |
$55.79
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.62
|
| Rate for Payer: Healthfirst Commercial |
$22.16
|
| Rate for Payer: Healthfirst Essential Plan |
$49.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.05
|
| Rate for Payer: Healthfirst QHP |
$22.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.62
|
| Rate for Payer: SOMOS Essential |
$16.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.16
|
|
|
PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$154.77
|
|
|
Service Code
|
HCPCS 92250
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$93.17 |
| Rate for Payer: Amida Care Medicaid |
$55.79
|
| Rate for Payer: Cash Price |
$42.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.06
|
| Rate for Payer: Healthfirst Commercial |
$41.41
|
| Rate for Payer: Healthfirst Essential Plan |
$93.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.34
|
| Rate for Payer: Healthfirst QHP |
$41.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.06
|
| Rate for Payer: SOMOS Essential |
$31.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.41
|
|
|
PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$71.75
|
|
|
Service Code
|
HCPCS 92250 TC
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$55.79 |
| Rate for Payer: Amida Care Medicaid |
$55.79
|
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.44
|
| Rate for Payer: Healthfirst Commercial |
$19.25
|
| Rate for Payer: Healthfirst Essential Plan |
$43.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.29
|
| Rate for Payer: Healthfirst QHP |
$19.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.44
|
| Rate for Payer: SOMOS Essential |
$14.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.25
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$143.71
|
|
|
Service Code
|
HCPCS 93304 26
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$106.52 |
| Rate for Payer: Amida Care Medicaid |
$106.52
|
| Rate for Payer: Cash Price |
$38.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.16
|
| Rate for Payer: Healthfirst Commercial |
$37.55
|
| Rate for Payer: Healthfirst Essential Plan |
$84.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.67
|
| Rate for Payer: Healthfirst QHP |
$37.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.16
|
| Rate for Payer: SOMOS Essential |
$28.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.55
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$518.67
|
|
|
Service Code
|
HCPCS 93304 TC
|
| Min. Negotiated Rate |
$95.42 |
| Max. Negotiated Rate |
$306.72 |
| Rate for Payer: Amida Care Medicaid |
$106.52
|
| Rate for Payer: Cash Price |
$142.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.24
|
| Rate for Payer: Healthfirst Commercial |
$136.32
|
| Rate for Payer: Healthfirst Essential Plan |
$306.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.50
|
| Rate for Payer: Healthfirst QHP |
$136.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.24
|
| Rate for Payer: SOMOS Essential |
$102.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.32
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$662.34
|
|
|
Service Code
|
HCPCS 93304
|
| Min. Negotiated Rate |
$106.52 |
| Max. Negotiated Rate |
$391.21 |
| Rate for Payer: Amida Care Medicaid |
$106.52
|
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$165.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$165.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.40
|
| Rate for Payer: Healthfirst Commercial |
$173.87
|
| Rate for Payer: Healthfirst Essential Plan |
$391.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$165.18
|
| Rate for Payer: Healthfirst QHP |
$173.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.40
|
| Rate for Payer: SOMOS Essential |
$130.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.87
|
|
|
PR FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT
|
Professional
|
Both
|
$3,691.38
|
|
|
Service Code
|
HCPCS 26820
|
| Min. Negotiated Rate |
$686.19 |
| Max. Negotiated Rate |
$2,205.61 |
| Rate for Payer: Cash Price |
$994.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$980.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$882.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$882.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$931.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$980.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$931.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$980.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$980.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$735.20
|
| Rate for Payer: Healthfirst Commercial |
$980.27
|
| Rate for Payer: Healthfirst Essential Plan |
$2,205.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$931.26
|
| Rate for Payer: Healthfirst QHP |
$980.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$686.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$980.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$833.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$686.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$980.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$735.20
|
| Rate for Payer: SOMOS Essential |
$735.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$980.27
|
|
|
PR GAMETE ZYGOTE/EMBRYO FALLOPIAN TRANSFER ANY METH
|
Professional
|
Both
|
$923.69
|
|
|
Service Code
|
HCPCS 58976
|
| Min. Negotiated Rate |
$170.73 |
| Max. Negotiated Rate |
$548.77 |
| Rate for Payer: Cash Price |
$246.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$243.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$219.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$219.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$231.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$243.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$231.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.93
|
| Rate for Payer: Healthfirst Commercial |
$243.90
|
| Rate for Payer: Healthfirst Essential Plan |
$548.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.71
|
| Rate for Payer: Healthfirst QHP |
$243.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$170.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$243.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$207.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$170.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$243.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$182.93
|
| Rate for Payer: SOMOS Essential |
$182.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$243.90
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$137.87
|
|
|
Service Code
|
HCPCS 94727 TC
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$87.86 |
| Rate for Payer: Amida Care Medicaid |
$19.53
|
| Rate for Payer: Cash Price |
$39.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.29
|
| Rate for Payer: Healthfirst Commercial |
$39.05
|
| Rate for Payer: Healthfirst Essential Plan |
$87.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.10
|
| Rate for Payer: Healthfirst QHP |
$39.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.29
|
| Rate for Payer: SOMOS Essential |
$29.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.05
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$46.80
|
|
|
Service Code
|
HCPCS 94727 26
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$28.53 |
| Rate for Payer: Amida Care Medicaid |
$19.53
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.51
|
| Rate for Payer: Healthfirst Commercial |
$12.68
|
| Rate for Payer: Healthfirst Essential Plan |
$28.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.51
|
| Rate for Payer: SOMOS Essential |
$9.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.68
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$184.66
|
|
|
Service Code
|
HCPCS 94727
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$116.39 |
| Rate for Payer: Amida Care Medicaid |
$19.53
|
| Rate for Payer: Cash Price |
$51.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.80
|
| Rate for Payer: Healthfirst Commercial |
$51.73
|
| Rate for Payer: Healthfirst Essential Plan |
$116.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.14
|
| Rate for Payer: Healthfirst QHP |
$51.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.80
|
| Rate for Payer: SOMOS Essential |
$38.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.73
|
|
|
PR GASTRIC INTUBAT DX W/ASPIRATION SINGLE SPECIMEN
|
Professional
|
Both
|
$165.66
|
|
|
Service Code
|
HCPCS 43754
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$102.06 |
| Rate for Payer: Cash Price |
$45.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.02
|
| Rate for Payer: Healthfirst Commercial |
$45.36
|
| Rate for Payer: Healthfirst Essential Plan |
$102.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.09
|
| Rate for Payer: Healthfirst QHP |
$45.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.02
|
| Rate for Payer: SOMOS Essential |
$34.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.36
|
|
