|
PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS
|
Professional
|
Both
|
$1,133.30
|
|
|
Service Code
|
HCPCS 31267
|
| Min. Negotiated Rate |
$211.95 |
| Max. Negotiated Rate |
$681.25 |
| Rate for Payer: Cash Price |
$306.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$302.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$272.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$272.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$287.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$302.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$287.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$302.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$302.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$227.09
|
| Rate for Payer: Healthfirst Commercial |
$302.78
|
| Rate for Payer: Healthfirst Essential Plan |
$681.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$287.64
|
| Rate for Payer: Healthfirst QHP |
$302.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$211.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$302.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$257.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$211.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$302.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$227.09
|
| Rate for Payer: SOMOS Essential |
$227.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$302.78
|
|
|
PR NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS
|
Professional
|
Both
|
$1,002.72
|
|
|
Service Code
|
HCPCS 31288
|
| Min. Negotiated Rate |
$187.59 |
| Max. Negotiated Rate |
$602.98 |
| Rate for Payer: Cash Price |
$270.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$267.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$241.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$267.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$267.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.99
|
| Rate for Payer: Healthfirst Commercial |
$267.99
|
| Rate for Payer: Healthfirst Essential Plan |
$602.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$254.59
|
| Rate for Payer: Healthfirst QHP |
$267.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$187.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$267.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$227.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$187.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$267.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$200.99
|
| Rate for Payer: SOMOS Essential |
$200.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$267.99
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 11-20 MIN
|
Professional
|
Both
|
$145.78
|
|
|
Service Code
|
HCPCS 99447
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$89.69 |
| Rate for Payer: Cash Price |
$40.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.89
|
| Rate for Payer: Healthfirst Commercial |
$39.86
|
| Rate for Payer: Healthfirst Essential Plan |
$89.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.87
|
| Rate for Payer: Healthfirst QHP |
$39.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.89
|
| Rate for Payer: SOMOS Essential |
$29.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.86
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 21-30 MIN
|
Professional
|
Both
|
$223.55
|
|
|
Service Code
|
HCPCS 99448
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$132.68 |
| Rate for Payer: Cash Price |
$60.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.23
|
| Rate for Payer: Healthfirst Commercial |
$58.97
|
| Rate for Payer: Healthfirst Essential Plan |
$132.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.02
|
| Rate for Payer: Healthfirst QHP |
$58.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.23
|
| Rate for Payer: SOMOS Essential |
$44.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.97
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 31/> MIN
|
Professional
|
Both
|
$293.13
|
|
|
Service Code
|
HCPCS 99449
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$180.22 |
| Rate for Payer: Cash Price |
$80.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.08
|
| Rate for Payer: Healthfirst Commercial |
$80.10
|
| Rate for Payer: Healthfirst Essential Plan |
$180.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.09
|
| Rate for Payer: Healthfirst QHP |
$80.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.08
|
| Rate for Payer: SOMOS Essential |
$60.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.10
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5-10 MIN
|
Professional
|
Both
|
$74.90
|
|
|
Service Code
|
HCPCS 99446
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$44.39 |
| Rate for Payer: Cash Price |
$19.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.80
|
| Rate for Payer: Healthfirst Commercial |
$19.73
|
| Rate for Payer: Healthfirst Essential Plan |
$44.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.74
|
| Rate for Payer: Healthfirst QHP |
$19.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.80
|
| Rate for Payer: SOMOS Essential |
$14.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.73
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5/> MIN
|
Professional
|
Both
|
$143.19
|
|
|
Service Code
|
HCPCS 99451
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$84.28 |
| Rate for Payer: Cash Price |
$38.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.09
|
| Rate for Payer: Healthfirst Commercial |
$37.46
|
| Rate for Payer: Healthfirst Essential Plan |
$84.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.59
|
| Rate for Payer: Healthfirst QHP |
$37.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.09
|
| Rate for Payer: SOMOS Essential |
$28.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.46
|
|
|
PR NTRPROF PHONE/NTRNET/EHR REFERRAL SVC 30 MIN
|
Professional
|
Both
|
$133.11
|
|
|
Service Code
|
HCPCS 99452
|
| Min. Negotiated Rate |
$26.76 |
| Max. Negotiated Rate |
$86.02 |
| Rate for Payer: Cash Price |
$37.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.67
|
| Rate for Payer: Healthfirst Commercial |
$38.23
|
| Rate for Payer: Healthfirst Essential Plan |
$86.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.32
|
| Rate for Payer: Healthfirst QHP |
$38.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.67
|
| Rate for Payer: SOMOS Essential |
$28.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.23
|
|
|
PR NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS
|
Professional
|
Both
|
$7,326.20
|
|
|
Service Code
|
HCPCS 62161
|
| Min. Negotiated Rate |
$1,344.82 |
| Max. Negotiated Rate |
$4,322.63 |
| Rate for Payer: Cash Price |
$1,942.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,921.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,729.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,729.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,825.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,921.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,825.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,921.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,921.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,440.88
|
| Rate for Payer: Healthfirst Commercial |
$1,921.17
|
| Rate for Payer: Healthfirst Essential Plan |
$4,322.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,825.11
|
| Rate for Payer: Healthfirst QHP |
$1,921.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,344.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,921.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,632.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,344.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,921.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,440.88
|
| Rate for Payer: SOMOS Essential |
$1,440.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,921.17
|
|
|
PR NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID
|
Professional
|
Both
|
$7,004.90
|
|
|
Service Code
|
HCPCS 62165
|
| Min. Negotiated Rate |
$1,288.25 |
| Max. Negotiated Rate |
$4,140.81 |
| Rate for Payer: Cash Price |
$1,860.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,840.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,656.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,656.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,748.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,840.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,748.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,840.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,840.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,380.27
|
| Rate for Payer: Healthfirst Commercial |
$1,840.36
|
| Rate for Payer: Healthfirst Essential Plan |
$4,140.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,748.34
|
| Rate for Payer: Healthfirst QHP |
$1,840.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,288.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,840.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,564.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,288.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,840.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,380.27
|
| Rate for Payer: SOMOS Essential |
$1,380.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,840.36
|
|
|
PR NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG
|
Professional
|
Both
|
$9,119.92
|
|
|
Service Code
|
HCPCS 62162
|
| Min. Negotiated Rate |
$1,667.88 |
| Max. Negotiated Rate |
$5,361.03 |
| Rate for Payer: Cash Price |
$2,405.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,382.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,144.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,144.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,263.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,382.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,263.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,382.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,382.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,787.01
|
| Rate for Payer: Healthfirst Commercial |
$2,382.68
|
| Rate for Payer: Healthfirst Essential Plan |
$5,361.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,263.55
|
| Rate for Payer: Healthfirst QHP |
$2,382.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,667.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,382.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,025.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,667.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,382.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,787.01
|
| Rate for Payer: SOMOS Essential |
$1,787.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,382.68
|
|
|
PR NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS
|
Professional
|
Both
|
$909.65
|
|
|
Service Code
|
HCPCS 62160
|
| Min. Negotiated Rate |
$164.96 |
| Max. Negotiated Rate |
$530.24 |
| Rate for Payer: Cash Price |
$237.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$235.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$212.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$212.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$223.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$235.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$223.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$176.75
|
| Rate for Payer: Healthfirst Commercial |
$235.66
|
| Rate for Payer: Healthfirst Essential Plan |
$530.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$223.88
|
| Rate for Payer: Healthfirst QHP |
$235.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$164.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$235.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$200.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$164.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$235.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$176.75
|
| Rate for Payer: SOMOS Essential |
$176.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$235.66
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME
|
Professional
|
Both
|
$534.87
|
|
|
Service Code
|
HCPCS 99316
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$323.46 |
| Rate for Payer: Amida Care Medicaid |
$30.62
|
| Rate for Payer: Cash Price |
$146.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$143.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.82
|
| Rate for Payer: Healthfirst Commercial |
$143.76
|
| Rate for Payer: Healthfirst Essential Plan |
$323.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.57
|
| Rate for Payer: Healthfirst QHP |
$143.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.82
|
| Rate for Payer: SOMOS Essential |
$107.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.76
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME
|
Professional
|
Both
|
$331.66
|
|
|
Service Code
|
HCPCS 99315
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$202.66 |
| Rate for Payer: Amida Care Medicaid |
$23.48
|
| Rate for Payer: Cash Price |
$91.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.55
|
| Rate for Payer: Healthfirst Commercial |
$90.07
|
| Rate for Payer: Healthfirst Essential Plan |
$202.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.57
|
| Rate for Payer: Healthfirst QHP |
$90.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.55
|
| Rate for Payer: SOMOS Essential |
$67.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.07
|
|
|
PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX
|
Professional
|
Both
|
$15.82
|
|
|
Service Code
|
HCPCS 94690 26
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$50.41 |
| Rate for Payer: Amida Care Medicaid |
$50.41
|
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.14
|
| Rate for Payer: Healthfirst Commercial |
$4.19
|
| Rate for Payer: Healthfirst Essential Plan |
$9.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.98
|
| Rate for Payer: Healthfirst QHP |
$4.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.14
|
| Rate for Payer: SOMOS Essential |
$3.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.19
|
|
|
PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX
|
Professional
|
Both
|
$189.60
|
|
|
Service Code
|
HCPCS 94690 TC
|
| Min. Negotiated Rate |
$36.57 |
| Max. Negotiated Rate |
$117.54 |
| Rate for Payer: Amida Care Medicaid |
$50.41
|
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.18
|
| Rate for Payer: Healthfirst Commercial |
$52.24
|
| Rate for Payer: Healthfirst Essential Plan |
$117.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.63
|
| Rate for Payer: Healthfirst QHP |
$52.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.18
|
| Rate for Payer: SOMOS Essential |
$39.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.24
|
|
|
PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX
|
Professional
|
Both
|
$205.42
|
|
|
Service Code
|
HCPCS 94690
|
| Min. Negotiated Rate |
$39.51 |
| Max. Negotiated Rate |
$126.99 |
| Rate for Payer: Amida Care Medicaid |
$50.41
|
| Rate for Payer: Cash Price |
$57.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.33
|
| Rate for Payer: Healthfirst Commercial |
$56.44
|
| Rate for Payer: Healthfirst Essential Plan |
$126.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.62
|
| Rate for Payer: Healthfirst QHP |
$56.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.33
|
| Rate for Payer: SOMOS Essential |
$42.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.44
|
|
|
PR O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC
|
Professional
|
Both
|
$37.84
|
|
|
Service Code
|
HCPCS 94681 26
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$64.57 |
| Rate for Payer: Amida Care Medicaid |
$64.57
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.67
|
| Rate for Payer: Healthfirst Commercial |
$10.23
|
| Rate for Payer: Healthfirst Essential Plan |
$23.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.72
|
| Rate for Payer: Healthfirst QHP |
$10.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.67
|
| Rate for Payer: SOMOS Essential |
$7.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.23
|
|
|
PR O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC
|
Professional
|
Both
|
$163.59
|
|
|
Service Code
|
HCPCS 94681 TC
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Amida Care Medicaid |
$64.57
|
| Rate for Payer: Cash Price |
$46.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.12
|
| Rate for Payer: Healthfirst Commercial |
$45.49
|
| Rate for Payer: Healthfirst Essential Plan |
$102.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.22
|
| Rate for Payer: Healthfirst QHP |
$45.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.12
|
| Rate for Payer: SOMOS Essential |
$34.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.49
|
|
|
PR O2 UPTK EXP GAS ALYS W/CO2 OUTPUT % O2 XTRC
|
Professional
|
Both
|
$201.46
|
|
|
Service Code
|
HCPCS 94681
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$125.35 |
| Rate for Payer: Amida Care Medicaid |
$64.57
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.78
|
| Rate for Payer: Healthfirst Commercial |
$55.71
|
| Rate for Payer: Healthfirst Essential Plan |
$125.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.92
|
| Rate for Payer: Healthfirst QHP |
$55.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.78
|
| Rate for Payer: SOMOS Essential |
$41.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.71
|
|
|
PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP
|
Professional
|
Both
|
$50.96
|
|
|
Service Code
|
HCPCS 94680 26
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$54.08 |
| Rate for Payer: Amida Care Medicaid |
$54.08
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.27
|
| Rate for Payer: Healthfirst Commercial |
$13.69
|
| Rate for Payer: Healthfirst Essential Plan |
$30.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.01
|
| Rate for Payer: Healthfirst QHP |
$13.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.27
|
| Rate for Payer: SOMOS Essential |
$10.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.69
|
|
|
PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP
|
Professional
|
Both
|
$175.11
|
|
|
Service Code
|
HCPCS 94680 TC
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Amida Care Medicaid |
$54.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.57
|
| Rate for Payer: Healthfirst Commercial |
$47.43
|
| Rate for Payer: Healthfirst Essential Plan |
$106.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.06
|
| Rate for Payer: Healthfirst QHP |
$47.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.57
|
| Rate for Payer: SOMOS Essential |
$35.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.43
|
|
|
PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP
|
Professional
|
Both
|
$226.07
|
|
|
Service Code
|
HCPCS 94680
|
| Min. Negotiated Rate |
$42.78 |
| Max. Negotiated Rate |
$137.50 |
| Rate for Payer: Amida Care Medicaid |
$54.08
|
| Rate for Payer: Cash Price |
$63.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.83
|
| Rate for Payer: Healthfirst Commercial |
$61.11
|
| Rate for Payer: Healthfirst Essential Plan |
$137.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.05
|
| Rate for Payer: Healthfirst QHP |
$61.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.83
|
| Rate for Payer: SOMOS Essential |
$45.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.11
|
|
|
PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM
|
Professional
|
Both
|
$12,239.68
|
|
|
Service Code
|
HCPCS 59510
|
| Min. Negotiated Rate |
$2,270.40 |
| Max. Negotiated Rate |
$7,297.72 |
| Rate for Payer: Cash Price |
$3,298.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,243.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,919.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,919.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,081.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,243.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,081.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,243.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,243.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,432.57
|
| Rate for Payer: Healthfirst Commercial |
$3,243.43
|
| Rate for Payer: Healthfirst Essential Plan |
$7,297.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,081.26
|
| Rate for Payer: Healthfirst QHP |
$3,243.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,270.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,243.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,756.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,270.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,243.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,432.57
|
| Rate for Payer: SOMOS Essential |
$2,432.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,243.43
|
|
|
PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM
|
Professional
|
Both
|
$10,931.24
|
|
|
Service Code
|
HCPCS 59400
|
| Min. Negotiated Rate |
$2,027.45 |
| Max. Negotiated Rate |
$6,516.81 |
| Rate for Payer: Cash Price |
$2,942.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,896.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,606.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,606.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,751.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,896.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,751.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,896.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,896.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,172.27
|
| Rate for Payer: Healthfirst Commercial |
$2,896.36
|
| Rate for Payer: Healthfirst Essential Plan |
$6,516.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,751.54
|
| Rate for Payer: Healthfirst QHP |
$2,896.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,027.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,896.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,461.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,027.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,896.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,172.27
|
| Rate for Payer: SOMOS Essential |
$2,172.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,896.36
|
|
