|
PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES
|
Professional
|
Both
|
$291.97
|
|
|
Service Code
|
HCPCS 95076
|
| Min. Negotiated Rate |
$38.94 |
| Max. Negotiated Rate |
$179.12 |
| Rate for Payer: Amida Care Medicaid |
$38.94
|
| Rate for Payer: Cash Price |
$80.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.71
|
| Rate for Payer: Healthfirst Commercial |
$79.61
|
| Rate for Payer: Healthfirst Essential Plan |
$179.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.63
|
| Rate for Payer: Healthfirst QHP |
$79.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.71
|
| Rate for Payer: SOMOS Essential |
$59.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.61
|
|
|
PR INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX
|
Professional
|
Both
|
$3,709.27
|
|
|
Service Code
|
HCPCS 38760
|
| Min. Negotiated Rate |
$692.11 |
| Max. Negotiated Rate |
$2,224.64 |
| Rate for Payer: Cash Price |
$994.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$988.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$889.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$889.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$939.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$988.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$939.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$988.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$988.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$741.55
|
| Rate for Payer: Healthfirst Commercial |
$988.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,224.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$939.29
|
| Rate for Payer: Healthfirst QHP |
$988.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$692.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$988.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$840.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$692.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$988.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$741.55
|
| Rate for Payer: SOMOS Essential |
$741.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$988.73
|
|
|
PR INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC
|
Professional
|
Both
|
$5,805.87
|
|
|
Service Code
|
HCPCS 38765
|
| Min. Negotiated Rate |
$1,082.18 |
| Max. Negotiated Rate |
$3,478.43 |
| Rate for Payer: Cash Price |
$1,552.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,545.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,391.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,391.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,468.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,545.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,468.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,545.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,545.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,159.48
|
| Rate for Payer: Healthfirst Commercial |
$1,545.97
|
| Rate for Payer: Healthfirst Essential Plan |
$3,478.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,468.67
|
| Rate for Payer: Healthfirst QHP |
$1,545.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,082.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,545.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,314.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,082.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,545.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,159.48
|
| Rate for Payer: SOMOS Essential |
$1,159.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,545.97
|
|
|
PR INHLJ BRNCL CHALLENGE TSTG W/HISTAM/METHACHOL
|
Professional
|
Both
|
$150.68
|
|
|
Service Code
|
HCPCS 95070
|
| Min. Negotiated Rate |
$29.28 |
| Max. Negotiated Rate |
$94.12 |
| Rate for Payer: Cash Price |
$41.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.37
|
| Rate for Payer: Healthfirst Commercial |
$41.83
|
| Rate for Payer: Healthfirst Essential Plan |
$94.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.74
|
| Rate for Payer: Healthfirst QHP |
$41.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.37
|
| Rate for Payer: SOMOS Essential |
$31.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.83
|
|
|
PR INITIAL FOOT EXAM PT LOPS
|
Professional
|
Both
|
$157.12
|
|
|
Service Code
|
HCPCS G0245
|
| Min. Negotiated Rate |
$29.74 |
| Max. Negotiated Rate |
$95.60 |
| Rate for Payer: Cash Price |
$43.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.87
|
| Rate for Payer: Healthfirst Commercial |
$42.49
|
| Rate for Payer: Healthfirst Essential Plan |
$95.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.37
|
| Rate for Payer: Healthfirst QHP |
$42.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.87
|
| Rate for Payer: SOMOS Essential |
$31.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.49
|
|
|
PR INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL
|
Professional
|
Both
|
$1,369.17
|
|
|
Service Code
|
HCPCS 99477
|
| Min. Negotiated Rate |
$133.76 |
| Max. Negotiated Rate |
$830.81 |
| Rate for Payer: Amida Care Medicaid |
$133.76
|
| Rate for Payer: Cash Price |
$374.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$369.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$332.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$332.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$350.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$369.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$350.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$369.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$369.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$276.94
|
| Rate for Payer: Healthfirst Commercial |
$369.25
|
| Rate for Payer: Healthfirst Essential Plan |
$830.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$350.79
|
| Rate for Payer: Healthfirst QHP |
$369.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$258.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$369.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$313.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$258.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$369.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$276.94
|
| Rate for Payer: SOMOS Essential |
$276.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$369.25
|
|
|
PR INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES
|
Professional
|
Both
|
$737.17
|
|
|
Service Code
|
HCPCS 99306
|
| Min. Negotiated Rate |
$56.31 |
| Max. Negotiated Rate |
$450.36 |
| Rate for Payer: Amida Care Medicaid |
$56.31
|
| Rate for Payer: Cash Price |
$202.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$200.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$190.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$200.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$190.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.12
|
| Rate for Payer: Healthfirst Commercial |
$200.16
|
| Rate for Payer: Healthfirst Essential Plan |
$450.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$190.15
|
| Rate for Payer: Healthfirst QHP |
$200.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$200.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$170.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$200.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.12
|
| Rate for Payer: SOMOS Essential |
$150.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.16
|
|
|
PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$543.48
|
|
|
Service Code
|
HCPCS 99305
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$330.44 |
| Rate for Payer: Amida Care Medicaid |
$44.00
|
| Rate for Payer: Cash Price |
$148.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.14
|
| Rate for Payer: Healthfirst Commercial |
$146.86
|
| Rate for Payer: Healthfirst Essential Plan |
$330.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.52
|
| Rate for Payer: Healthfirst QHP |
$146.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.14
|
| Rate for Payer: SOMOS Essential |
$110.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.86
|
|
|
PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN
|
Professional
|
Both
|
$328.65
|
|
|
Service Code
|
HCPCS 99304
|
| Min. Negotiated Rate |
$31.69 |
| Max. Negotiated Rate |
$201.08 |
| Rate for Payer: Amida Care Medicaid |
$31.69
|
| Rate for Payer: Cash Price |
$89.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.03
|
| Rate for Payer: Healthfirst Commercial |
$89.37
|
| Rate for Payer: Healthfirst Essential Plan |
$201.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.90
|
| Rate for Payer: Healthfirst QHP |
$89.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.03
|
| Rate for Payer: SOMOS Essential |
$67.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.37
|
|
|
PR INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS
|
Professional
|
Both
|
$3,126.69
|
|
|
Service Code
|
HCPCS 99471
|
| Min. Negotiated Rate |
$319.67 |
| Max. Negotiated Rate |
$1,893.78 |
| Rate for Payer: Amida Care Medicaid |
$319.67
|
| Rate for Payer: Cash Price |
$856.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$841.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$757.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$757.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$799.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$841.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$799.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$841.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$841.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$631.26
|
| Rate for Payer: Healthfirst Commercial |
$841.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,893.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$799.60
|
| Rate for Payer: Healthfirst QHP |
$841.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$589.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$841.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$715.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$589.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$841.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$631.26
|
| Rate for Payer: SOMOS Essential |
$631.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$841.68
|
|
|
PR INITIAL PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$2,276.30
|
|
|
Service Code
|
HCPCS 99475
|
| Min. Negotiated Rate |
$431.03 |
| Max. Negotiated Rate |
$1,385.46 |
| Rate for Payer: Cash Price |
$621.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$615.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$554.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$554.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$584.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$615.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$584.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$615.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$615.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$461.82
|
| Rate for Payer: Healthfirst Commercial |
$615.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,385.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$584.97
|
| Rate for Payer: Healthfirst QHP |
$615.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$431.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$615.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$523.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$431.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$615.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$461.82
|
| Rate for Payer: SOMOS Essential |
$461.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$615.76
|
|
|
PR INITIAL PREVENTIVE EXAM
|
Professional
|
Both
|
$533.02
|
|
|
Service Code
|
HCPCS G0402
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$322.47 |
| Rate for Payer: Cash Price |
$145.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$143.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.49
|
| Rate for Payer: Healthfirst Commercial |
$143.32
|
| Rate for Payer: Healthfirst Essential Plan |
$322.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.15
|
| Rate for Payer: Healthfirst QHP |
$143.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.49
|
| Rate for Payer: SOMOS Essential |
$107.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.32
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR
|
Professional
|
Both
|
$248.25
|
|
|
Service Code
|
HCPCS 99381
|
| Min. Negotiated Rate |
$28.89 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Amida Care Medicaid |
$28.89
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
HCPCS 99386
|
| Min. Negotiated Rate |
$45.71 |
| Max. Negotiated Rate |
$45.71 |
| Rate for Payer: Amida Care Medicaid |
$45.71
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 99387
|
| Min. Negotiated Rate |
$49.67 |
| Max. Negotiated Rate |
$49.67 |
| Rate for Payer: Amida Care Medicaid |
$49.67
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR
|
Professional
|
Both
|
$308.25
|
|
|
Service Code
|
HCPCS 99384
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$37.20 |
| Rate for Payer: Amida Care Medicaid |
$37.20
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS
|
Professional
|
Both
|
$258.75
|
|
|
Service Code
|
HCPCS 99382
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Amida Care Medicaid |
$33.05
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS
|
Professional
|
Both
|
$299.25
|
|
|
Service Code
|
HCPCS 99385
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$37.20 |
| Rate for Payer: Amida Care Medicaid |
$37.20
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS
|
Professional
|
Both
|
$268.50
|
|
|
Service Code
|
HCPCS 99383
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Amida Care Medicaid |
$33.05
|
|
|
PR INITIAL TX 1ST DEGREE BURN LOCAL TX
|
Professional
|
Both
|
$197.23
|
|
|
Service Code
|
HCPCS 16000
|
| Min. Negotiated Rate |
$36.92 |
| Max. Negotiated Rate |
$118.67 |
| Rate for Payer: Cash Price |
$52.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.55
|
| Rate for Payer: Healthfirst Commercial |
$52.74
|
| Rate for Payer: Healthfirst Essential Plan |
$118.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.10
|
| Rate for Payer: Healthfirst QHP |
$52.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.55
|
| Rate for Payer: SOMOS Essential |
$39.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.74
|
|
|
PR INITIAT MED ASSIST TX IN ER
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS G2213
|
| Min. Negotiated Rate |
$44.91 |
| Max. Negotiated Rate |
$144.34 |
| Rate for Payer: Cash Price |
$67.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.11
|
| Rate for Payer: Healthfirst Commercial |
$64.15
|
| Rate for Payer: Healthfirst Essential Plan |
$144.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.94
|
| Rate for Payer: Healthfirst QHP |
$64.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.11
|
| Rate for Payer: SOMOS Essential |
$48.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.15
|
|
|
PR INITIAT SELECTIVE HEAD/BODY HYPOTHERMIA NEONATE
|
Professional
|
Both
|
$865.62
|
|
|
Service Code
|
HCPCS 99184
|
| Min. Negotiated Rate |
$126.14 |
| Max. Negotiated Rate |
$524.50 |
| Rate for Payer: Amida Care Medicaid |
$126.14
|
| Rate for Payer: Cash Price |
$236.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$233.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$209.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$221.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$233.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$221.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.83
|
| Rate for Payer: Healthfirst Commercial |
$233.11
|
| Rate for Payer: Healthfirst Essential Plan |
$524.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$221.45
|
| Rate for Payer: Healthfirst QHP |
$233.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$163.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$233.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$198.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$163.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$233.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.83
|
| Rate for Payer: SOMOS Essential |
$174.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$233.11
|
|
|
PR INIT/SUB PSYCH CARE M 1ST 30
|
Professional
|
Both
|
$151.94
|
|
|
Service Code
|
HCPCS G2214
|
| Min. Negotiated Rate |
$29.27 |
| Max. Negotiated Rate |
$94.07 |
| Rate for Payer: Cash Price |
$42.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.36
|
| Rate for Payer: Healthfirst Commercial |
$41.81
|
| Rate for Payer: Healthfirst Essential Plan |
$94.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.72
|
| Rate for Payer: Healthfirst QHP |
$41.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.36
|
| Rate for Payer: SOMOS Essential |
$31.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.81
|
|
|
PR INJ DX/THER AGNT PARAVERT FACET JOINT,IMG GUIDE,CERV/THORAC, 1ST LEVEL
|
Professional
|
Both
|
$435.33
|
|
|
Service Code
|
HCPCS 64490
|
| Min. Negotiated Rate |
$83.03 |
| Max. Negotiated Rate |
$266.89 |
| Rate for Payer: Cash Price |
$119.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.97
|
| Rate for Payer: Healthfirst Commercial |
$118.62
|
| Rate for Payer: Healthfirst Essential Plan |
$266.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.69
|
| Rate for Payer: Healthfirst QHP |
$118.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.97
|
| Rate for Payer: SOMOS Essential |
$88.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.62
|
|
|
PR INJECT EVALUATE PREVIOUS PERITONEAL-VENOUS SHUNT
|
Professional
|
Both
|
$163.14
|
|
|
Service Code
|
HCPCS 49427
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$99.65 |
| Rate for Payer: Cash Price |
$43.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.22
|
| Rate for Payer: Healthfirst Commercial |
$44.29
|
| Rate for Payer: Healthfirst Essential Plan |
$99.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.08
|
| Rate for Payer: Healthfirst QHP |
$44.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.22
|
| Rate for Payer: SOMOS Essential |
$33.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.29
|
|
