|
PR MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ
|
Professional
|
Both
|
$64.93
|
|
|
Service Code
|
HCPCS 94200
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$39.85 |
| Rate for Payer: Amida Care Medicaid |
$18.38
|
| Rate for Payer: Cash Price |
$17.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.28
|
| Rate for Payer: Healthfirst Commercial |
$17.71
|
| Rate for Payer: Healthfirst Essential Plan |
$39.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.82
|
| Rate for Payer: Healthfirst QHP |
$17.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.28
|
| Rate for Payer: SOMOS Essential |
$13.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.71
|
|
|
PR MAX BREATHING CAPACITY MAXIMAL VOLUNTARY VENTJ
|
Professional
|
Both
|
$53.06
|
|
|
Service Code
|
HCPCS 94200 TC
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Amida Care Medicaid |
$18.38
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.94
|
| Rate for Payer: Healthfirst Commercial |
$14.59
|
| Rate for Payer: Healthfirst Essential Plan |
$32.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.86
|
| Rate for Payer: Healthfirst QHP |
$14.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.94
|
| Rate for Payer: SOMOS Essential |
$10.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.59
|
|
|
PR MAXILLARY IMPRESJ PALATAL PROSTHESIS
|
Professional
|
Both
|
$462.74
|
|
|
Service Code
|
HCPCS 42280
|
| Min. Negotiated Rate |
$86.83 |
| Max. Negotiated Rate |
$279.11 |
| Rate for Payer: Cash Price |
$124.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.04
|
| Rate for Payer: Healthfirst Commercial |
$124.05
|
| Rate for Payer: Healthfirst Essential Plan |
$279.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.85
|
| Rate for Payer: Healthfirst QHP |
$124.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.04
|
| Rate for Payer: SOMOS Essential |
$93.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.05
|
|
|
PR MAXILLECTOMY W/O ORBITAL EXENTERATION
|
Professional
|
Both
|
$7,772.45
|
|
|
Service Code
|
HCPCS 31225
|
| Min. Negotiated Rate |
$1,448.70 |
| Max. Negotiated Rate |
$4,656.53 |
| Rate for Payer: Cash Price |
$2,096.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,069.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,862.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,862.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,966.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,069.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,966.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,069.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,069.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,552.18
|
| Rate for Payer: Healthfirst Commercial |
$2,069.57
|
| Rate for Payer: Healthfirst Essential Plan |
$4,656.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,966.09
|
| Rate for Payer: Healthfirst QHP |
$2,069.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,448.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,069.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,759.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,448.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,069.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,552.18
|
| Rate for Payer: SOMOS Essential |
$1,552.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,069.57
|
|
|
PR MAXILLECTOMY W/ORBITAL EXENTERATION
|
Professional
|
Both
|
$8,668.28
|
|
|
Service Code
|
HCPCS 31230
|
| Min. Negotiated Rate |
$1,616.01 |
| Max. Negotiated Rate |
$5,194.31 |
| Rate for Payer: Cash Price |
$2,338.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,308.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,077.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,077.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,193.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,308.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,193.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,308.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,308.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,731.43
|
| Rate for Payer: Healthfirst Commercial |
$2,308.58
|
| Rate for Payer: Healthfirst Essential Plan |
$5,194.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,193.15
|
| Rate for Payer: Healthfirst QHP |
$2,308.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,616.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,308.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,962.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,616.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,308.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,731.43
|
| Rate for Payer: SOMOS Essential |
$1,731.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,308.58
|
|
|
PR MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN
|
Professional
|
Both
|
$185.99
|
|
|
Service Code
|
HCPCS 36596
|
| Min. Negotiated Rate |
$36.59 |
| Max. Negotiated Rate |
$117.61 |
| Rate for Payer: Cash Price |
$51.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.20
|
| Rate for Payer: Healthfirst Commercial |
$52.27
|
| Rate for Payer: Healthfirst Essential Plan |
$117.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.66
|
| Rate for Payer: Healthfirst QHP |
$52.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.20
|
| Rate for Payer: SOMOS Essential |
$39.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.27
|
|
|
PR MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS
|
Professional
|
Both
|
$748.55
|
|
|
Service Code
|
HCPCS 36595
|
| Min. Negotiated Rate |
$140.34 |
| Max. Negotiated Rate |
$451.08 |
| Rate for Payer: Cash Price |
$201.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$200.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$190.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$200.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$190.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.36
|
| Rate for Payer: Healthfirst Commercial |
$200.48
|
| Rate for Payer: Healthfirst Essential Plan |
$451.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$190.46
|
| Rate for Payer: Healthfirst QHP |
$200.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$200.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$170.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$200.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.36
|
| Rate for Payer: SOMOS Essential |
$150.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.48
|
|
|
PR MD CERTIFICATION HHA PATIENT
|
Professional
|
Both
|
$215.60
|
|
|
Service Code
|
HCPCS G0180
|
| Min. Negotiated Rate |
$42.34 |
| Max. Negotiated Rate |
$136.10 |
| Rate for Payer: Cash Price |
$61.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.37
|
| Rate for Payer: Healthfirst Commercial |
$60.49
|
| Rate for Payer: Healthfirst Essential Plan |
$136.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.47
|
| Rate for Payer: Healthfirst QHP |
$60.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.37
|
| Rate for Payer: SOMOS Essential |
$45.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.49
|
|
|
PR MD DOCUMENT VISIT BY NPP
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS G0454
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$21.46 |
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.16
|
| Rate for Payer: Healthfirst Commercial |
$9.54
|
| Rate for Payer: Healthfirst Essential Plan |
$21.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.06
|
| Rate for Payer: Healthfirst QHP |
$9.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.16
|
| Rate for Payer: SOMOS Essential |
$7.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.54
|
|
|
PR MD RECERTIFICATION HHA PT
|
Professional
|
Both
|
$173.67
|
|
|
Service Code
|
HCPCS G0179
|
| Min. Negotiated Rate |
$33.61 |
| Max. Negotiated Rate |
$108.05 |
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.02
|
| Rate for Payer: Healthfirst Commercial |
$48.02
|
| Rate for Payer: Healthfirst Essential Plan |
$108.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.62
|
| Rate for Payer: Healthfirst QHP |
$48.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.02
|
| Rate for Payer: SOMOS Essential |
$36.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.02
|
|
|
PR MD REVIEW INTERPRET OF TEST
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS G0250
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$21.46 |
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.16
|
| Rate for Payer: Healthfirst Commercial |
$9.54
|
| Rate for Payer: Healthfirst Essential Plan |
$21.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.06
|
| Rate for Payer: Healthfirst QHP |
$9.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.16
|
| Rate for Payer: SOMOS Essential |
$7.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.54
|
|
|
PR MD SERVICE REQUIRED FOR PMD
|
Professional
|
Both
|
$35.53
|
|
|
Service Code
|
HCPCS G0372
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$21.82 |
| Rate for Payer: Amida Care Medicaid |
$21.82
|
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.18
|
| Rate for Payer: Healthfirst Commercial |
$9.58
|
| Rate for Payer: Healthfirst Essential Plan |
$21.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.10
|
| Rate for Payer: Healthfirst QHP |
$9.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.18
|
| Rate for Payer: SOMOS Essential |
$7.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.58
|
|
|
PR MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP
|
Professional
|
Both
|
$47.29
|
|
|
Service Code
|
HCPCS 51798
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$31.61 |
| Rate for Payer: Cash Price |
$13.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.54
|
| Rate for Payer: Healthfirst Commercial |
$14.05
|
| Rate for Payer: Healthfirst Essential Plan |
$31.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.35
|
| Rate for Payer: Healthfirst QHP |
$14.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.54
|
| Rate for Payer: SOMOS Essential |
$10.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.05
|
|
|
PR MEAS SPIRO FRCD EXP FLO PRE&POST BRONCH INF/2YRS
|
Professional
|
Both
|
$556.99
|
|
|
Service Code
|
HCPCS 94012
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$338.67 |
| Rate for Payer: Amida Care Medicaid |
$76.88
|
| Rate for Payer: Cash Price |
$153.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.89
|
| Rate for Payer: Healthfirst Commercial |
$150.52
|
| Rate for Payer: Healthfirst Essential Plan |
$338.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.99
|
| Rate for Payer: Healthfirst QHP |
$150.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.89
|
| Rate for Payer: SOMOS Essential |
$112.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.52
|
|
|
PR MEAS SPIROMTRC FORCD EXPIRATORY FLO INFANT&/2 Y
|
Professional
|
Both
|
$344.02
|
|
|
Service Code
|
HCPCS 94011
|
| Min. Negotiated Rate |
$50.03 |
| Max. Negotiated Rate |
$208.75 |
| Rate for Payer: Amida Care Medicaid |
$50.03
|
| Rate for Payer: Cash Price |
$93.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.58
|
| Rate for Payer: Healthfirst Commercial |
$92.78
|
| Rate for Payer: Healthfirst Essential Plan |
$208.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.14
|
| Rate for Payer: Healthfirst QHP |
$92.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.58
|
| Rate for Payer: SOMOS Essential |
$69.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.78
|
|
|
PR MEASUREMENT LUNG VOLUMES INFANT/CHILD/2 YRS
|
Professional
|
Both
|
$78.12
|
|
|
Service Code
|
HCPCS 94013
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$45.56 |
| Rate for Payer: Amida Care Medicaid |
$16.18
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.19
|
| Rate for Payer: Healthfirst Commercial |
$20.25
|
| Rate for Payer: Healthfirst Essential Plan |
$45.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.24
|
| Rate for Payer: Healthfirst QHP |
$20.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.19
|
| Rate for Payer: SOMOS Essential |
$15.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.25
|
|
|
PR MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT
|
Professional
|
Both
|
$404.08
|
|
|
Service Code
|
HCPCS 53020
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$245.88 |
| Rate for Payer: Cash Price |
$110.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$103.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$103.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.96
|
| Rate for Payer: Healthfirst Commercial |
$109.28
|
| Rate for Payer: Healthfirst Essential Plan |
$245.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$103.82
|
| Rate for Payer: Healthfirst QHP |
$109.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$92.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$81.96
|
| Rate for Payer: SOMOS Essential |
$81.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.28
|
|
|
PR MEATOTOMY CUTTING MEATUS SPX INFANT
|
Professional
|
Both
|
$287.67
|
|
|
Service Code
|
HCPCS 53025
|
| Min. Negotiated Rate |
$55.48 |
| Max. Negotiated Rate |
$178.31 |
| Rate for Payer: Cash Price |
$78.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.44
|
| Rate for Payer: Healthfirst Commercial |
$79.25
|
| Rate for Payer: Healthfirst Essential Plan |
$178.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.29
|
| Rate for Payer: Healthfirst QHP |
$79.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.44
|
| Rate for Payer: SOMOS Essential |
$59.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.25
|
|
|
PR MECHANICAL CHEST WALL OSCILLATION LUNG FUNCTION
|
Professional
|
Both
|
$85.96
|
|
|
Service Code
|
HCPCS 94669
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Cash Price |
$24.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.68
|
| Rate for Payer: Healthfirst Commercial |
$24.91
|
| Rate for Payer: Healthfirst Essential Plan |
$56.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.66
|
| Rate for Payer: Healthfirst QHP |
$24.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.68
|
| Rate for Payer: SOMOS Essential |
$18.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.91
|
|
|
PR MEDIAL CANTHOPEXY SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,478.35
|
|
|
Service Code
|
HCPCS 21280
|
| Min. Negotiated Rate |
$472.14 |
| Max. Negotiated Rate |
$1,517.58 |
| Rate for Payer: Cash Price |
$681.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$674.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$607.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$607.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$640.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$674.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$640.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$674.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$674.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$505.86
|
| Rate for Payer: Healthfirst Commercial |
$674.48
|
| Rate for Payer: Healthfirst Essential Plan |
$1,517.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$640.76
|
| Rate for Payer: Healthfirst QHP |
$674.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$472.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$674.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$573.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$472.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$674.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$505.86
|
| Rate for Payer: SOMOS Essential |
$505.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$674.48
|
|
|
PR MEDIASTINOSCOPY INCLUDES MEDIASTINAL MASS BIOPSY
|
Professional
|
Both
|
$1,367.94
|
|
|
Service Code
|
HCPCS 39401
|
| Min. Negotiated Rate |
$253.73 |
| Max. Negotiated Rate |
$815.56 |
| Rate for Payer: Cash Price |
$363.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$326.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$326.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$344.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$344.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$362.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$271.85
|
| Rate for Payer: Healthfirst Commercial |
$362.47
|
| Rate for Payer: Healthfirst Essential Plan |
$815.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$344.35
|
| Rate for Payer: Healthfirst QHP |
$362.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$253.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$362.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$308.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$253.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$271.85
|
| Rate for Payer: SOMOS Essential |
$271.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.47
|
|
|
PR MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES
|
Professional
|
Both
|
$1,789.80
|
|
|
Service Code
|
HCPCS 39402
|
| Min. Negotiated Rate |
$331.57 |
| Max. Negotiated Rate |
$1,065.76 |
| Rate for Payer: Cash Price |
$476.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$473.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$426.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$426.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$449.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$473.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$449.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$473.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$473.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$355.25
|
| Rate for Payer: Healthfirst Commercial |
$473.67
|
| Rate for Payer: Healthfirst Essential Plan |
$1,065.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$449.99
|
| Rate for Payer: Healthfirst QHP |
$473.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$331.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$473.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$402.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$331.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$473.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$355.25
|
| Rate for Payer: SOMOS Essential |
$355.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$473.67
|
|
|
PR MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR
|
Professional
|
Both
|
$2,123.77
|
|
|
Service Code
|
HCPCS 39000
|
| Min. Negotiated Rate |
$417.18 |
| Max. Negotiated Rate |
$1,340.93 |
| Rate for Payer: Cash Price |
$601.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$595.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$536.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$536.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$566.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$595.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$566.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$595.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$595.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$446.98
|
| Rate for Payer: Healthfirst Commercial |
$595.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,340.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$566.17
|
| Rate for Payer: Healthfirst QHP |
$595.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$417.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$595.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$506.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$417.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$595.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$446.98
|
| Rate for Payer: SOMOS Essential |
$446.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$595.97
|
|
|
PR MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 39010
|
| Min. Negotiated Rate |
$651.47 |
| Max. Negotiated Rate |
$2,094.01 |
| Rate for Payer: Cash Price |
$937.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$930.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$837.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$837.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$884.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$930.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$884.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$930.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$930.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$698.00
|
| Rate for Payer: Healthfirst Commercial |
$930.67
|
| Rate for Payer: Healthfirst Essential Plan |
$2,094.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$884.14
|
| Rate for Payer: Healthfirst QHP |
$930.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$651.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$930.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$791.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$651.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$930.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$698.00
|
| Rate for Payer: SOMOS Essential |
$698.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$930.67
|
|
|
PR MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI
|
Professional
|
Both
|
$129.50
|
|
|
Service Code
|
HCPCS 97802
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$80.03 |
| Rate for Payer: Cash Price |
$35.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.68
|
| Rate for Payer: Healthfirst Commercial |
$35.57
|
| Rate for Payer: Healthfirst Essential Plan |
$80.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.79
|
| Rate for Payer: Healthfirst QHP |
$35.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.68
|
| Rate for Payer: SOMOS Essential |
$26.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.57
|
|
