|
PR NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE
|
Professional
|
Both
|
$171.26
|
|
|
Service Code
|
HCPCS 27369
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$102.42 |
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.14
|
| Rate for Payer: Healthfirst Commercial |
$45.52
|
| Rate for Payer: Healthfirst Essential Plan |
$102.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.24
|
| Rate for Payer: Healthfirst QHP |
$45.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.14
|
| Rate for Payer: SOMOS Essential |
$34.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.52
|
|
|
PR NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH
|
Professional
|
Both
|
$207.20
|
|
|
Service Code
|
HCPCS 36005
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$121.21 |
| Rate for Payer: Cash Price |
$54.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.40
|
| Rate for Payer: Healthfirst Commercial |
$53.87
|
| Rate for Payer: Healthfirst Essential Plan |
$121.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.18
|
| Rate for Payer: Healthfirst QHP |
$53.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.40
|
| Rate for Payer: SOMOS Essential |
$40.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.87
|
|
|
PR NJX RETROGRADE URETHROCSTOGRAPY
|
Professional
|
Both
|
$267.86
|
|
|
Service Code
|
HCPCS 51610
|
| Min. Negotiated Rate |
$51.87 |
| Max. Negotiated Rate |
$166.72 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.58
|
| Rate for Payer: Healthfirst Commercial |
$74.10
|
| Rate for Payer: Healthfirst Essential Plan |
$166.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.39
|
| Rate for Payer: Healthfirst QHP |
$74.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.58
|
| Rate for Payer: SOMOS Essential |
$55.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.10
|
|
|
PR NJX SEL HRT ART CONGENITAL HRT CATH W/S&I
|
Professional
|
Both
|
$222.08
|
|
|
Service Code
|
HCPCS 93563
|
| Min. Negotiated Rate |
$21.81 |
| Max. Negotiated Rate |
$130.32 |
| Rate for Payer: Amida Care Medicaid |
$21.81
|
| Rate for Payer: Cash Price |
$58.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.44
|
| Rate for Payer: Healthfirst Commercial |
$57.92
|
| Rate for Payer: Healthfirst Essential Plan |
$130.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.02
|
| Rate for Payer: Healthfirst QHP |
$57.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.44
|
| Rate for Payer: SOMOS Essential |
$43.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.92
|
|
|
PR NJX SEL HRT ART/GRFT CONGENITAL HRT CATH W/S&I
|
Professional
|
Both
|
$242.24
|
|
|
Service Code
|
HCPCS 93564
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$143.26 |
| Rate for Payer: Amida Care Medicaid |
$22.20
|
| Rate for Payer: Cash Price |
$64.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$63.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.75
|
| Rate for Payer: Healthfirst Commercial |
$63.67
|
| Rate for Payer: Healthfirst Essential Plan |
$143.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.49
|
| Rate for Payer: Healthfirst QHP |
$63.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.75
|
| Rate for Payer: SOMOS Essential |
$47.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.67
|
|
|
PR NJX SEL L VENT/ATRIAL ANGIO HRT CATH W/S&I
|
Professional
|
Both
|
$119.91
|
|
|
Service Code
|
HCPCS 93565
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$71.69 |
| Rate for Payer: Amida Care Medicaid |
$16.91
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.89
|
| Rate for Payer: Healthfirst Commercial |
$31.86
|
| Rate for Payer: Healthfirst Essential Plan |
$71.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.27
|
| Rate for Payer: Healthfirst QHP |
$31.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.89
|
| Rate for Payer: SOMOS Essential |
$23.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.86
|
|
|
PR NJX SEL R VENT/ATRIAL ANGIO HRT CATH W/S&I
|
Professional
|
Both
|
$115.85
|
|
|
Service Code
|
HCPCS 93566
|
| Min. Negotiated Rate |
$16.79 |
| Max. Negotiated Rate |
$65.61 |
| Rate for Payer: Amida Care Medicaid |
$16.79
|
| Rate for Payer: Cash Price |
$29.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.87
|
| Rate for Payer: Healthfirst Commercial |
$29.16
|
| Rate for Payer: Healthfirst Essential Plan |
$65.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.70
|
| Rate for Payer: Healthfirst QHP |
$29.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.87
|
| Rate for Payer: SOMOS Essential |
$21.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.16
|
|
|
PR NJX SUPRAVALV AORTOG HRT CATH W/S&I
|
Professional
|
Both
|
$168.70
|
|
|
Service Code
|
HCPCS 93567
|
| Min. Negotiated Rate |
$18.90 |
| Max. Negotiated Rate |
$97.47 |
| Rate for Payer: Amida Care Medicaid |
$18.90
|
| Rate for Payer: Cash Price |
$43.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.49
|
| Rate for Payer: Healthfirst Commercial |
$43.32
|
| Rate for Payer: Healthfirst Essential Plan |
$97.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.15
|
| Rate for Payer: Healthfirst QHP |
$43.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.49
|
| Rate for Payer: SOMOS Essential |
$32.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.32
|
|
|
PR NJX VISUALIZATION ILEAL CONDUIT&/URETEROPYELOG
|
Professional
|
Both
|
$290.26
|
|
|
Service Code
|
HCPCS 50690
|
| Min. Negotiated Rate |
$55.88 |
| Max. Negotiated Rate |
$179.62 |
| Rate for Payer: Cash Price |
$79.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.87
|
| Rate for Payer: Healthfirst Commercial |
$79.83
|
| Rate for Payer: Healthfirst Essential Plan |
$179.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.84
|
| Rate for Payer: Healthfirst QHP |
$79.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.87
|
| Rate for Payer: SOMOS Essential |
$59.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.83
|
|
|
PR NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST
|
Professional
|
Both
|
$440.72
|
|
|
Service Code
|
HCPCS 54250 26
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$266.99 |
| Rate for Payer: Cash Price |
$119.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.00
|
| Rate for Payer: Healthfirst Commercial |
$118.66
|
| Rate for Payer: Healthfirst Essential Plan |
$266.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.73
|
| Rate for Payer: Healthfirst QHP |
$118.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.00
|
| Rate for Payer: SOMOS Essential |
$89.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.66
|
|
|
PR NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST
|
Professional
|
Both
|
$63.11
|
|
|
Service Code
|
HCPCS 54250 TC
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.98
|
| Rate for Payer: Healthfirst Commercial |
$17.31
|
| Rate for Payer: Healthfirst Essential Plan |
$38.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.44
|
| Rate for Payer: Healthfirst QHP |
$17.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.98
|
| Rate for Payer: SOMOS Essential |
$12.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.31
|
|
|
PR NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST
|
Professional
|
Both
|
$503.83
|
|
|
Service Code
|
HCPCS 54250
|
| Min. Negotiated Rate |
$95.17 |
| Max. Negotiated Rate |
$305.91 |
| Rate for Payer: Cash Price |
$137.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$135.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.97
|
| Rate for Payer: Healthfirst Commercial |
$135.96
|
| Rate for Payer: Healthfirst Essential Plan |
$305.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.16
|
| Rate for Payer: Healthfirst QHP |
$135.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$135.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$135.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.97
|
| Rate for Payer: SOMOS Essential |
$101.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.96
|
|
|
PR NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER
|
Professional
|
Both
|
$17.12
|
|
|
Service Code
|
HCPCS 94761
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.67
|
| Rate for Payer: Healthfirst Commercial |
$4.89
|
| Rate for Payer: Healthfirst Essential Plan |
$11.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.65
|
| Rate for Payer: Healthfirst QHP |
$4.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.67
|
| Rate for Payer: SOMOS Essential |
$3.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.89
|
|
|
PR NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR
|
Professional
|
Both
|
$110.57
|
|
|
Service Code
|
HCPCS 94762
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$65.14 |
| Rate for Payer: Cash Price |
$30.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.71
|
| Rate for Payer: Healthfirst Commercial |
$28.95
|
| Rate for Payer: Healthfirst Essential Plan |
$65.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.50
|
| Rate for Payer: Healthfirst QHP |
$28.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.71
|
| Rate for Payer: SOMOS Essential |
$21.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.95
|
|
|
PR NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER
|
Professional
|
Both
|
$11.38
|
|
|
Service Code
|
HCPCS 94760
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.38
|
| Rate for Payer: Healthfirst Commercial |
$4.50
|
| Rate for Payer: Healthfirst Essential Plan |
$10.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.28
|
| Rate for Payer: Healthfirst QHP |
$4.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.38
|
| Rate for Payer: SOMOS Essential |
$3.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.50
|
|
|
PR NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS
|
Professional
|
Both
|
$91.46
|
|
|
Service Code
|
HCPCS 93923 26
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$154.25 |
| Rate for Payer: Amida Care Medicaid |
$154.25
|
| Rate for Payer: Cash Price |
$24.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.73
|
| Rate for Payer: Healthfirst Commercial |
$23.64
|
| Rate for Payer: Healthfirst Essential Plan |
$53.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.46
|
| Rate for Payer: Healthfirst QHP |
$23.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.73
|
| Rate for Payer: SOMOS Essential |
$17.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.64
|
|
|
PR NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS
|
Professional
|
Both
|
$462.60
|
|
|
Service Code
|
HCPCS 93923 TC
|
| Min. Negotiated Rate |
$89.06 |
| Max. Negotiated Rate |
$286.27 |
| Rate for Payer: Amida Care Medicaid |
$154.25
|
| Rate for Payer: Cash Price |
$129.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.42
|
| Rate for Payer: Healthfirst Commercial |
$127.23
|
| Rate for Payer: Healthfirst Essential Plan |
$286.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.87
|
| Rate for Payer: Healthfirst QHP |
$127.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.42
|
| Rate for Payer: SOMOS Essential |
$95.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.23
|
|
|
PR NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVLS
|
Professional
|
Both
|
$554.05
|
|
|
Service Code
|
HCPCS 93923
|
| Min. Negotiated Rate |
$105.61 |
| Max. Negotiated Rate |
$339.46 |
| Rate for Payer: Amida Care Medicaid |
$154.25
|
| Rate for Payer: Cash Price |
$153.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.15
|
| Rate for Payer: Healthfirst Commercial |
$150.87
|
| Rate for Payer: Healthfirst Essential Plan |
$339.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.33
|
| Rate for Payer: Healthfirst QHP |
$150.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.15
|
| Rate for Payer: SOMOS Essential |
$113.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.87
|
|
|
PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL
|
Professional
|
Both
|
$52.33
|
|
|
Service Code
|
HCPCS 93922 26
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Amida Care Medicaid |
$100.80
|
| Rate for Payer: Cash Price |
$13.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.88
|
| Rate for Payer: Healthfirst Commercial |
$13.18
|
| Rate for Payer: Healthfirst Essential Plan |
$29.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.52
|
| Rate for Payer: Healthfirst QHP |
$13.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.88
|
| Rate for Payer: SOMOS Essential |
$9.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.18
|
|
|
PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL
|
Professional
|
Both
|
$356.79
|
|
|
Service Code
|
HCPCS 93922
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$214.11 |
| Rate for Payer: Amida Care Medicaid |
$100.80
|
| Rate for Payer: Cash Price |
$97.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.37
|
| Rate for Payer: Healthfirst Commercial |
$95.16
|
| Rate for Payer: Healthfirst Essential Plan |
$214.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.40
|
| Rate for Payer: Healthfirst QHP |
$95.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.37
|
| Rate for Payer: SOMOS Essential |
$71.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.16
|
|
|
PR NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 2 LEVEL
|
Professional
|
Both
|
$304.47
|
|
|
Service Code
|
HCPCS 93922 TC
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$184.43 |
| Rate for Payer: Amida Care Medicaid |
$100.80
|
| Rate for Payer: Cash Price |
$83.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.48
|
| Rate for Payer: Healthfirst Commercial |
$81.97
|
| Rate for Payer: Healthfirst Essential Plan |
$184.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.87
|
| Rate for Payer: Healthfirst QHP |
$81.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.48
|
| Rate for Payer: SOMOS Essential |
$61.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.97
|
|
|
PR NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN
|
Professional
|
Both
|
$86.80
|
|
|
Service Code
|
HCPCS 98967
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$55.51 |
| Rate for Payer: Cash Price |
$24.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.50
|
| Rate for Payer: Healthfirst Commercial |
$24.67
|
| Rate for Payer: Healthfirst Essential Plan |
$55.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.44
|
| Rate for Payer: Healthfirst QHP |
$24.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.50
|
| Rate for Payer: SOMOS Essential |
$18.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.67
|
|
|
PR NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN
|
Professional
|
Both
|
$120.96
|
|
|
Service Code
|
HCPCS 98968
|
| Min. Negotiated Rate |
$23.84 |
| Max. Negotiated Rate |
$76.64 |
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.55
|
| Rate for Payer: Healthfirst Commercial |
$34.06
|
| Rate for Payer: Healthfirst Essential Plan |
$76.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.36
|
| Rate for Payer: Healthfirst QHP |
$34.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.55
|
| Rate for Payer: SOMOS Essential |
$25.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.06
|
|
|
PR NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN
|
Professional
|
Both
|
$44.10
|
|
|
Service Code
|
HCPCS 98966
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$28.62 |
| Rate for Payer: Cash Price |
$12.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.54
|
| Rate for Payer: Healthfirst Commercial |
$12.72
|
| Rate for Payer: Healthfirst Essential Plan |
$28.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.08
|
| Rate for Payer: Healthfirst QHP |
$12.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.54
|
| Rate for Payer: SOMOS Essential |
$9.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.72
|
|
|
PR NONSLCTV CATH THOR AORTA ANGIO INTR/XTRCRANL ART
|
Professional
|
Both
|
$873.18
|
|
|
Service Code
|
HCPCS 36221
|
| Min. Negotiated Rate |
$161.52 |
| Max. Negotiated Rate |
$519.16 |
| Rate for Payer: Cash Price |
$233.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$207.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$207.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.06
|
| Rate for Payer: Healthfirst Commercial |
$230.74
|
| Rate for Payer: Healthfirst Essential Plan |
$519.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$219.20
|
| Rate for Payer: Healthfirst QHP |
$230.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$161.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$196.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$161.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$173.06
|
| Rate for Payer: SOMOS Essential |
$173.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.74
|
|
