|
PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$241.99
|
|
|
Service Code
|
HCPCS 90632
|
| Min. Negotiated Rate |
$51.65 |
| Max. Negotiated Rate |
$166.03 |
| Rate for Payer: Cash Price |
$70.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.34
|
| Rate for Payer: Healthfirst Commercial |
$73.79
|
| Rate for Payer: Healthfirst Essential Plan |
$166.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.10
|
| Rate for Payer: Healthfirst QHP |
$73.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.34
|
| Rate for Payer: SOMOS Essential |
$55.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.79
|
|
|
PR HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM
|
Professional
|
Both
|
$160.25
|
|
|
Service Code
|
HCPCS 90743
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$169.09 |
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.36
|
| Rate for Payer: Healthfirst Commercial |
$75.15
|
| Rate for Payer: Healthfirst Essential Plan |
$169.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.39
|
| Rate for Payer: Healthfirst QHP |
$75.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.36
|
| Rate for Payer: SOMOS Essential |
$56.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.15
|
|
|
PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$162.86
|
|
|
Service Code
|
HCPCS 90746
|
| Min. Negotiated Rate |
$49.27 |
| Max. Negotiated Rate |
$158.35 |
| Rate for Payer: Cash Price |
$70.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.78
|
| Rate for Payer: Healthfirst Commercial |
$70.38
|
| Rate for Payer: Healthfirst Essential Plan |
$158.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.86
|
| Rate for Payer: Healthfirst QHP |
$70.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.78
|
| Rate for Payer: SOMOS Essential |
$52.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.38
|
|
|
PR HEPB VACCINE DIALYSIS/IMMUNSUP PAT 4 DOSE IM
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 90747
|
| Min. Negotiated Rate |
$98.53 |
| Max. Negotiated Rate |
$316.69 |
| Rate for Payer: Cash Price |
$140.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.56
|
| Rate for Payer: Healthfirst Commercial |
$140.75
|
| Rate for Payer: Healthfirst Essential Plan |
$316.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.71
|
| Rate for Payer: Healthfirst QHP |
$140.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.56
|
| Rate for Payer: SOMOS Essential |
$105.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.75
|
|
|
PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Professional
|
Both
|
$69.88
|
|
|
Service Code
|
HCPCS 90744
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$71.26 |
| Rate for Payer: Cash Price |
$30.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.75
|
| Rate for Payer: Healthfirst Commercial |
$31.67
|
| Rate for Payer: Healthfirst Essential Plan |
$71.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.09
|
| Rate for Payer: Healthfirst QHP |
$31.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.75
|
| Rate for Payer: SOMOS Essential |
$23.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.67
|
|
|
PR HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT
|
Professional
|
Both
|
$54.50
|
|
|
Service Code
|
HCPCS 94452 26
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$34.16 |
| Rate for Payer: Cash Price |
$14.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.38
|
| Rate for Payer: Healthfirst Commercial |
$15.18
|
| Rate for Payer: Healthfirst Essential Plan |
$34.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.42
|
| Rate for Payer: Healthfirst QHP |
$15.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.38
|
| Rate for Payer: SOMOS Essential |
$11.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.18
|
|
|
PR HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT
|
Professional
|
Both
|
$150.82
|
|
|
Service Code
|
HCPCS 94452 TC
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$96.59 |
| Rate for Payer: Cash Price |
$43.46
|
| 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 HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT
|
Professional
|
Both
|
$205.31
|
|
|
Service Code
|
HCPCS 94452
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$130.75 |
| Rate for Payer: Cash Price |
$58.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.58
|
| Rate for Payer: Healthfirst Commercial |
$58.11
|
| Rate for Payer: Healthfirst Essential Plan |
$130.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.20
|
| Rate for Payer: Healthfirst QHP |
$58.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.58
|
| Rate for Payer: SOMOS Essential |
$43.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.11
|
|
|
PR HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION
|
Professional
|
Both
|
$72.84
|
|
|
Service Code
|
HCPCS 94453 26
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$44.26 |
| Rate for Payer: Cash Price |
$19.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.75
|
| Rate for Payer: Healthfirst Commercial |
$19.67
|
| Rate for Payer: Healthfirst Essential Plan |
$44.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.69
|
| Rate for Payer: Healthfirst QHP |
$19.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.75
|
| Rate for Payer: SOMOS Essential |
$14.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.67
|
|
|
PR HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION
|
Professional
|
Both
|
$209.58
|
|
|
Service Code
|
HCPCS 94453 TC
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$129.42 |
| Rate for Payer: Cash Price |
$58.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.14
|
| Rate for Payer: Healthfirst Commercial |
$57.52
|
| Rate for Payer: Healthfirst Essential Plan |
$129.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.64
|
| Rate for Payer: Healthfirst QHP |
$57.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.14
|
| Rate for Payer: SOMOS Essential |
$43.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.52
|
|
|
PR HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION
|
Professional
|
Both
|
$282.42
|
|
|
Service Code
|
HCPCS 94453
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$173.68 |
| Rate for Payer: Cash Price |
$78.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.89
|
| Rate for Payer: Healthfirst Commercial |
$77.19
|
| Rate for Payer: Healthfirst Essential Plan |
$173.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.33
|
| Rate for Payer: Healthfirst QHP |
$77.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.89
|
| Rate for Payer: SOMOS Essential |
$57.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.19
|
|
|
PR HIGH INTEN BEH COUNS STD 30M
|
Professional
|
Both
|
$93.17
|
|
|
Service Code
|
HCPCS G0445
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$73.91 |
| Rate for Payer: Cash Price |
$25.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.64
|
| Rate for Payer: Healthfirst Commercial |
$32.85
|
| Rate for Payer: Healthfirst Essential Plan |
$73.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.21
|
| Rate for Payer: Healthfirst QHP |
$32.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.64
|
| Rate for Payer: SOMOS Essential |
$24.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.85
|
|
|
PR HISTOCHEMICAL STAIN
|
Professional
|
Both
|
$303.17
|
|
|
Service Code
|
HCPCS 88314 TC
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$174.82 |
| Rate for Payer: Cash Price |
$81.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.27
|
| Rate for Payer: Healthfirst Commercial |
$77.70
|
| Rate for Payer: Healthfirst Essential Plan |
$174.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.81
|
| Rate for Payer: Healthfirst QHP |
$77.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.27
|
| Rate for Payer: SOMOS Essential |
$58.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.70
|
|
|
PR HISTOCHEMICAL STAIN
|
Professional
|
Both
|
$79.21
|
|
|
Service Code
|
HCPCS 88314 26
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$46.76 |
| Rate for Payer: Cash Price |
$21.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.59
|
| Rate for Payer: Healthfirst Commercial |
$20.78
|
| Rate for Payer: Healthfirst Essential Plan |
$46.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.74
|
| Rate for Payer: Healthfirst QHP |
$20.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.59
|
| Rate for Payer: SOMOS Essential |
$15.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.78
|
|
|
PR HISTOCHEMICAL STAIN
|
Professional
|
Both
|
$382.41
|
|
|
Service Code
|
HCPCS 88314
|
| Min. Negotiated Rate |
$68.94 |
| Max. Negotiated Rate |
$221.58 |
| Rate for Payer: Cash Price |
$103.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.86
|
| Rate for Payer: Healthfirst Commercial |
$98.48
|
| Rate for Payer: Healthfirst Essential Plan |
$221.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.56
|
| Rate for Payer: Healthfirst QHP |
$98.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.86
|
| Rate for Payer: SOMOS Essential |
$73.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.48
|
|
|
PR HOME HEALTH CARE SUPERVISION
|
Professional
|
Both
|
$425.04
|
|
|
Service Code
|
HCPCS G0181
|
| Min. Negotiated Rate |
$82.66 |
| Max. Negotiated Rate |
$265.70 |
| Rate for Payer: Cash Price |
$118.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.57
|
| Rate for Payer: Healthfirst Commercial |
$118.09
|
| Rate for Payer: Healthfirst Essential Plan |
$265.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.19
|
| Rate for Payer: Healthfirst QHP |
$118.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.57
|
| Rate for Payer: SOMOS Essential |
$88.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.09
|
|
|
PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$756.49
|
|
|
Service Code
|
HCPCS 99350
|
| Min. Negotiated Rate |
$142.14 |
| Max. Negotiated Rate |
$456.88 |
| Rate for Payer: Cash Price |
$206.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$203.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$182.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$192.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$203.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$192.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$152.29
|
| Rate for Payer: Healthfirst Commercial |
$203.06
|
| Rate for Payer: Healthfirst Essential Plan |
$456.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$192.91
|
| Rate for Payer: Healthfirst QHP |
$203.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$203.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$172.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$203.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$152.29
|
| Rate for Payer: SOMOS Essential |
$152.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$203.06
|
|
|
PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$306.08
|
|
|
Service Code
|
HCPCS 99348
|
| Min. Negotiated Rate |
$58.93 |
| Max. Negotiated Rate |
$189.41 |
| Rate for Payer: Cash Price |
$84.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.13
|
| Rate for Payer: Healthfirst Commercial |
$84.18
|
| Rate for Payer: Healthfirst Essential Plan |
$189.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.97
|
| Rate for Payer: Healthfirst QHP |
$84.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.13
|
| Rate for Payer: SOMOS Essential |
$63.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.18
|
|
|
PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$518.88
|
|
|
Service Code
|
HCPCS 99349
|
| Min. Negotiated Rate |
$98.10 |
| Max. Negotiated Rate |
$315.31 |
| Rate for Payer: Cash Price |
$141.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.11
|
| Rate for Payer: Healthfirst Commercial |
$140.14
|
| Rate for Payer: Healthfirst Essential Plan |
$315.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.13
|
| Rate for Payer: Healthfirst QHP |
$140.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.11
|
| Rate for Payer: SOMOS Essential |
$105.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.14
|
|
|
PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES
|
Professional
|
Both
|
$178.29
|
|
|
Service Code
|
HCPCS 99347
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$111.13 |
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.04
|
| Rate for Payer: Healthfirst Commercial |
$49.39
|
| Rate for Payer: Healthfirst Essential Plan |
$111.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.92
|
| Rate for Payer: Healthfirst QHP |
$49.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.04
|
| Rate for Payer: SOMOS Essential |
$37.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.39
|
|
|
PR HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$820.30
|
|
|
Service Code
|
HCPCS 99345
|
| Min. Negotiated Rate |
$154.92 |
| Max. Negotiated Rate |
$497.95 |
| Rate for Payer: Cash Price |
$224.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$221.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$199.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$199.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$210.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$221.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$210.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$221.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.98
|
| Rate for Payer: Healthfirst Commercial |
$221.31
|
| Rate for Payer: Healthfirst Essential Plan |
$497.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.24
|
| Rate for Payer: Healthfirst QHP |
$221.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$221.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$188.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$221.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.98
|
| Rate for Payer: SOMOS Essential |
$165.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.31
|
|
|
PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$310.49
|
|
|
Service Code
|
HCPCS 99342
|
| Min. Negotiated Rate |
$59.66 |
| Max. Negotiated Rate |
$191.77 |
| Rate for Payer: Cash Price |
$86.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.92
|
| Rate for Payer: Healthfirst Commercial |
$85.23
|
| Rate for Payer: Healthfirst Essential Plan |
$191.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.97
|
| Rate for Payer: Healthfirst QHP |
$85.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.92
|
| Rate for Payer: SOMOS Essential |
$63.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.23
|
|
|
PR HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES
|
Professional
|
Both
|
$581.21
|
|
|
Service Code
|
HCPCS 99344
|
| Min. Negotiated Rate |
$108.74 |
| Max. Negotiated Rate |
$349.51 |
| Rate for Payer: Cash Price |
$157.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$155.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.50
|
| Rate for Payer: Healthfirst Commercial |
$155.34
|
| Rate for Payer: Healthfirst Essential Plan |
$349.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.57
|
| Rate for Payer: Healthfirst QHP |
$155.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.50
|
| Rate for Payer: SOMOS Essential |
$116.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.34
|
|
|
PR HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES
|
Professional
|
Both
|
$193.69
|
|
|
Service Code
|
HCPCS 99341
|
| Min. Negotiated Rate |
$37.53 |
| Max. Negotiated Rate |
$120.62 |
| Rate for Payer: Cash Price |
$54.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.21
|
| Rate for Payer: Healthfirst Commercial |
$53.61
|
| Rate for Payer: Healthfirst Essential Plan |
$120.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.93
|
| Rate for Payer: Healthfirst QHP |
$53.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.21
|
| Rate for Payer: SOMOS Essential |
$40.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.61
|
|
|
PR HOSPICE CARE SUPERVISION
|
Professional
|
Both
|
$427.91
|
|
|
Service Code
|
HCPCS G0182
|
| Min. Negotiated Rate |
$81.42 |
| Max. Negotiated Rate |
$261.70 |
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.23
|
| Rate for Payer: Healthfirst Commercial |
$116.31
|
| Rate for Payer: Healthfirst Essential Plan |
$261.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.49
|
| Rate for Payer: Healthfirst QHP |
$116.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.23
|
| Rate for Payer: SOMOS Essential |
$87.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.31
|
|
