|
PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG
|
Professional
|
Both
|
$1,792.70
|
|
|
Service Code
|
HCPCS 95805
|
| Min. Negotiated Rate |
$356.64 |
| Max. Negotiated Rate |
$1,146.35 |
| Rate for Payer: Amida Care Medicaid |
$437.98
|
| Rate for Payer: Cash Price |
$507.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$509.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$458.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$458.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$484.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$509.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$484.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$509.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$509.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$382.12
|
| Rate for Payer: Healthfirst Commercial |
$509.49
|
| Rate for Payer: Healthfirst Essential Plan |
$1,146.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$484.02
|
| Rate for Payer: Healthfirst QHP |
$509.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$356.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$509.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$433.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$356.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$509.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$382.12
|
| Rate for Payer: SOMOS Essential |
$382.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$509.49
|
|
|
PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG
|
Professional
|
Both
|
$1,569.65
|
|
|
Service Code
|
HCPCS 95805 TC
|
| Min. Negotiated Rate |
$314.02 |
| Max. Negotiated Rate |
$1,009.35 |
| Rate for Payer: Amida Care Medicaid |
$437.98
|
| Rate for Payer: Cash Price |
$446.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$448.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$403.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$403.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$426.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$448.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$426.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$448.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$448.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$336.45
|
| Rate for Payer: Healthfirst Commercial |
$448.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,009.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$426.17
|
| Rate for Payer: Healthfirst QHP |
$448.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$314.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$448.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$381.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$314.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$448.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$336.45
|
| Rate for Payer: SOMOS Essential |
$336.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$448.60
|
|
|
PR MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME
|
Professional
|
Both
|
$380.45
|
|
|
Service Code
|
HCPCS 20950
|
| Min. Negotiated Rate |
$72.94 |
| Max. Negotiated Rate |
$234.45 |
| Rate for Payer: Cash Price |
$104.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.15
|
| Rate for Payer: Healthfirst Commercial |
$104.20
|
| Rate for Payer: Healthfirst Essential Plan |
$234.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.99
|
| Rate for Payer: Healthfirst QHP |
$104.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.15
|
| Rate for Payer: SOMOS Essential |
$78.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.20
|
|
|
PR MNT SUBS TX FOR CHANGE DX
|
Professional
|
Both
|
$109.41
|
|
|
Service Code
|
HCPCS G0270
|
| Min. Negotiated Rate |
$21.06 |
| Max. Negotiated Rate |
$67.70 |
| Rate for Payer: Cash Price |
$30.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.57
|
| Rate for Payer: Healthfirst Commercial |
$30.09
|
| Rate for Payer: Healthfirst Essential Plan |
$67.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.59
|
| Rate for Payer: Healthfirst QHP |
$30.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.57
|
| Rate for Payer: SOMOS Essential |
$22.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.09
|
|
|
PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT
|
Professional
|
Both
|
$534.14
|
|
|
Service Code
|
HCPCS 44139
|
| Min. Negotiated Rate |
$98.50 |
| Max. Negotiated Rate |
$316.62 |
| Rate for Payer: Cash Price |
$141.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.54
|
| Rate for Payer: Healthfirst Commercial |
$140.72
|
| Rate for Payer: Healthfirst Essential Plan |
$316.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.68
|
| Rate for Payer: Healthfirst QHP |
$140.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.54
|
| Rate for Payer: SOMOS Essential |
$105.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.72
|
|
|
PR MODIFICAJ CONTACT LENS SPX SUPVJ ADAPTATION
|
Professional
|
Both
|
$195.37
|
|
|
Service Code
|
HCPCS 92325
|
| Min. Negotiated Rate |
$36.84 |
| Max. Negotiated Rate |
$118.42 |
| Rate for Payer: Cash Price |
$48.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.47
|
| Rate for Payer: Healthfirst Commercial |
$52.63
|
| Rate for Payer: Healthfirst Essential Plan |
$118.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.00
|
| Rate for Payer: Healthfirst QHP |
$52.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.47
|
| Rate for Payer: SOMOS Essential |
$39.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.63
|
|
|
PR MODIFICAJ OC IMPLT W/PLMT/RPLCMT PEGS SPX
|
Professional
|
Both
|
$1,216.85
|
|
|
Service Code
|
HCPCS 65125
|
| Min. Negotiated Rate |
$233.13 |
| Max. Negotiated Rate |
$749.36 |
| Rate for Payer: Cash Price |
$336.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$333.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$299.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$299.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$316.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$333.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$316.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$333.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$333.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$249.79
|
| Rate for Payer: Healthfirst Commercial |
$333.05
|
| Rate for Payer: Healthfirst Essential Plan |
$749.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$316.40
|
| Rate for Payer: Healthfirst QHP |
$333.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$233.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$333.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$283.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$233.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$333.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$249.79
|
| Rate for Payer: SOMOS Essential |
$249.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$333.05
|
|
|
PR MOD SEDAT ENDO SERVICE >5YRS
|
Professional
|
Both
|
$23.73
|
|
|
Service Code
|
HCPCS G0500
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$15.41 |
| Rate for Payer: Cash Price |
$6.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.14
|
| Rate for Payer: Healthfirst Commercial |
$6.85
|
| Rate for Payer: Healthfirst Essential Plan |
$15.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.51
|
| Rate for Payer: Healthfirst QHP |
$6.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.14
|
| Rate for Payer: SOMOS Essential |
$5.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.85
|
|
|
PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$254.21
|
|
|
Service Code
|
HCPCS 99157
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$143.80 |
| Rate for Payer: Amida Care Medicaid |
$30.99
|
| Rate for Payer: Cash Price |
$66.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$63.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.93
|
| Rate for Payer: Healthfirst Commercial |
$63.91
|
| Rate for Payer: Healthfirst Essential Plan |
$143.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.71
|
| Rate for Payer: Healthfirst QHP |
$63.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.93
|
| Rate for Payer: SOMOS Essential |
$47.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.91
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$341.57
|
|
|
Service Code
|
HCPCS 99155
|
| Min. Negotiated Rate |
$45.03 |
| Max. Negotiated Rate |
$207.04 |
| Rate for Payer: Amida Care Medicaid |
$45.03
|
| Rate for Payer: Cash Price |
$92.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.02
|
| Rate for Payer: Healthfirst Commercial |
$92.02
|
| Rate for Payer: Healthfirst Essential Plan |
$207.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.42
|
| Rate for Payer: Healthfirst QHP |
$92.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.02
|
| Rate for Payer: SOMOS Essential |
$69.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.02
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$314.86
|
|
|
Service Code
|
HCPCS 99156
|
| Min. Negotiated Rate |
$40.89 |
| Max. Negotiated Rate |
$184.21 |
| Rate for Payer: Amida Care Medicaid |
$40.89
|
| Rate for Payer: Cash Price |
$83.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.40
|
| Rate for Payer: Healthfirst Commercial |
$81.87
|
| Rate for Payer: Healthfirst Essential Plan |
$184.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.78
|
| Rate for Payer: Healthfirst QHP |
$81.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.40
|
| Rate for Payer: SOMOS Essential |
$61.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.87
|
|
|
PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$50.05
|
|
|
Service Code
|
HCPCS 99153
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$32.47 |
| Rate for Payer: Amida Care Medicaid |
$6.08
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.82
|
| Rate for Payer: Healthfirst Commercial |
$14.43
|
| Rate for Payer: Healthfirst Essential Plan |
$32.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.71
|
| Rate for Payer: Healthfirst QHP |
$14.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.82
|
| Rate for Payer: SOMOS Essential |
$10.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.43
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$99.44
|
|
|
Service Code
|
HCPCS 99151
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$58.66 |
| Rate for Payer: Amida Care Medicaid |
$12.78
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.55
|
| Rate for Payer: Healthfirst Commercial |
$26.07
|
| Rate for Payer: Healthfirst Essential Plan |
$58.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.77
|
| Rate for Payer: Healthfirst QHP |
$26.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.55
|
| Rate for Payer: SOMOS Essential |
$19.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.07
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$53.76
|
|
|
Service Code
|
HCPCS 99152
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Amida Care Medicaid |
$6.66
|
| Rate for Payer: Cash Price |
$13.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.18
|
| Rate for Payer: Healthfirst Commercial |
$13.57
|
| Rate for Payer: Healthfirst Essential Plan |
$30.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.89
|
| Rate for Payer: Healthfirst QHP |
$13.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.18
|
| Rate for Payer: SOMOS Essential |
$10.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.57
|
|
|
PR MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS
|
Professional
|
Both
|
$1,480.50
|
|
|
Service Code
|
HCPCS 17311
|
| Min. Negotiated Rate |
$279.36 |
| Max. Negotiated Rate |
$897.95 |
| Rate for Payer: Cash Price |
$400.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$399.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$359.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$359.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$379.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$399.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$379.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$399.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$399.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$299.32
|
| Rate for Payer: Healthfirst Commercial |
$399.09
|
| Rate for Payer: Healthfirst Essential Plan |
$897.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$379.14
|
| Rate for Payer: Healthfirst QHP |
$399.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$279.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$399.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$339.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$279.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$399.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$299.32
|
| Rate for Payer: SOMOS Essential |
$299.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$399.09
|
|
|
PR MOHS MICROGRAPHIC H/N/H/F/G EACH ADDL STAGE
|
Professional
|
Both
|
$789.39
|
|
|
Service Code
|
HCPCS 17312
|
| Min. Negotiated Rate |
$149.06 |
| Max. Negotiated Rate |
$479.14 |
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.71
|
| Rate for Payer: Healthfirst Commercial |
$212.95
|
| Rate for Payer: Healthfirst Essential Plan |
$479.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.30
|
| Rate for Payer: Healthfirst QHP |
$212.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$212.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.71
|
| Rate for Payer: SOMOS Essential |
$159.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.95
|
|
|
PR MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS
|
Professional
|
Both
|
$1,326.57
|
|
|
Service Code
|
HCPCS 17313
|
| Min. Negotiated Rate |
$251.17 |
| Max. Negotiated Rate |
$807.35 |
| Rate for Payer: Cash Price |
$359.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$358.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$322.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$322.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$340.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$358.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$340.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$358.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$358.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$269.12
|
| Rate for Payer: Healthfirst Commercial |
$358.82
|
| Rate for Payer: Healthfirst Essential Plan |
$807.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$340.88
|
| Rate for Payer: Healthfirst QHP |
$358.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$251.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$358.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$305.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$251.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$358.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$269.12
|
| Rate for Payer: SOMOS Essential |
$269.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$358.82
|
|
|
PR MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE
|
Professional
|
Both
|
$211.09
|
|
|
Service Code
|
HCPCS 17315
|
| Min. Negotiated Rate |
$38.84 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.62
|
| Rate for Payer: Healthfirst Commercial |
$55.49
|
| Rate for Payer: Healthfirst Essential Plan |
$124.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.72
|
| Rate for Payer: Healthfirst QHP |
$55.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.62
|
| Rate for Payer: SOMOS Essential |
$41.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.49
|
|
|
PR MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE
|
Professional
|
Both
|
$725.52
|
|
|
Service Code
|
HCPCS 17314
|
| Min. Negotiated Rate |
$137.04 |
| Max. Negotiated Rate |
$440.48 |
| Rate for Payer: Cash Price |
$197.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$195.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$176.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$195.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.83
|
| Rate for Payer: Healthfirst Commercial |
$195.77
|
| Rate for Payer: Healthfirst Essential Plan |
$440.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.98
|
| Rate for Payer: Healthfirst QHP |
$195.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$137.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$195.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$137.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$195.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.83
|
| Rate for Payer: SOMOS Essential |
$146.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.77
|
|
|
PR MOLECULAR PATHOLOGY INTERPR
|
Professional
|
Both
|
$183.75
|
|
|
Service Code
|
HCPCS G0452 26
|
| Min. Negotiated Rate |
$34.27 |
| Max. Negotiated Rate |
$110.16 |
| Rate for Payer: Cash Price |
$50.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.72
|
| Rate for Payer: Healthfirst Commercial |
$48.96
|
| Rate for Payer: Healthfirst Essential Plan |
$110.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.51
|
| Rate for Payer: Healthfirst QHP |
$48.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.72
|
| Rate for Payer: SOMOS Essential |
$36.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.96
|
|
|
PR MOLECULAR PATHOLOGY INTERPR
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS G0452
|
| Min. Negotiated Rate |
$37.15 |
| Max. Negotiated Rate |
$119.41 |
| Rate for Payer: Cash Price |
$54.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.80
|
| Rate for Payer: Healthfirst Commercial |
$53.07
|
| Rate for Payer: Healthfirst Essential Plan |
$119.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.42
|
| Rate for Payer: Healthfirst QHP |
$53.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.80
|
| Rate for Payer: SOMOS Essential |
$39.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.07
|
|
|
PR MOLECULAR PATHOLOGY INTERPR
|
Professional
|
Both
|
$14.25
|
|
|
Service Code
|
HCPCS G0452 TC
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$9.25 |
| Rate for Payer: Cash Price |
$4.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.08
|
| Rate for Payer: Healthfirst Commercial |
$4.11
|
| Rate for Payer: Healthfirst Essential Plan |
$9.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.90
|
| Rate for Payer: Healthfirst QHP |
$4.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.08
|
| Rate for Payer: SOMOS Essential |
$3.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.11
|
|
|
PR MOTION FLUOR EVAL SWLNG FUNCJ C/V REC
|
Professional
|
Both
|
$378.04
|
|
|
Service Code
|
HCPCS 92611
|
| Min. Negotiated Rate |
$57.24 |
| Max. Negotiated Rate |
$229.59 |
| Rate for Payer: Amida Care Medicaid |
$57.24
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$102.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.53
|
| Rate for Payer: Healthfirst Commercial |
$102.04
|
| Rate for Payer: Healthfirst Essential Plan |
$229.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.94
|
| Rate for Payer: Healthfirst QHP |
$102.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.53
|
| Rate for Payer: SOMOS Essential |
$76.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.04
|
|
|
PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
|
Professional
|
Both
|
$11.87
|
|
|
Service Code
|
HCPCS 95905 26
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$61.89 |
| Rate for Payer: Amida Care Medicaid |
$61.89
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.34
|
| Rate for Payer: Healthfirst Commercial |
$3.12
|
| Rate for Payer: Healthfirst Essential Plan |
$7.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.96
|
| Rate for Payer: Healthfirst QHP |
$3.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.34
|
| Rate for Payer: SOMOS Essential |
$2.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.12
|
|
|
PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
|
Professional
|
Both
|
$137.87
|
|
|
Service Code
|
HCPCS 95905 TC
|
| Min. Negotiated Rate |
$24.61 |
| Max. Negotiated Rate |
$79.11 |
| Rate for Payer: Amida Care Medicaid |
$61.89
|
| Rate for Payer: Cash Price |
$36.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.37
|
| Rate for Payer: Healthfirst Commercial |
$35.16
|
| Rate for Payer: Healthfirst Essential Plan |
$79.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.40
|
| Rate for Payer: Healthfirst QHP |
$35.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.37
|
| Rate for Payer: SOMOS Essential |
$26.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.16
|
|
