|
PR PHARYNGOLARYNGECTOMY W/RAD NECK DSJ W/RCNSTJ
|
Professional
|
Both
|
$12,661.74
|
|
|
Service Code
|
HCPCS 31395
|
| Min. Negotiated Rate |
$2,353.42 |
| Max. Negotiated Rate |
$7,564.57 |
| Rate for Payer: Cash Price |
$3,410.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,362.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,025.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,025.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,193.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,362.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,193.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,362.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,362.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,521.52
|
| Rate for Payer: Healthfirst Commercial |
$3,362.03
|
| Rate for Payer: Healthfirst Essential Plan |
$7,564.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,193.93
|
| Rate for Payer: Healthfirst QHP |
$3,362.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,353.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,362.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,857.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,353.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,362.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,521.52
|
| Rate for Payer: SOMOS Essential |
$2,521.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,362.03
|
|
|
PR PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX
|
Professional
|
Both
|
$3,461.43
|
|
|
Service Code
|
HCPCS 42950
|
| Min. Negotiated Rate |
$644.46 |
| Max. Negotiated Rate |
$2,071.46 |
| Rate for Payer: Cash Price |
$933.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$920.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$828.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$874.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$920.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$874.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$920.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$690.49
|
| Rate for Payer: Healthfirst Commercial |
$920.65
|
| Rate for Payer: Healthfirst Essential Plan |
$2,071.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$874.62
|
| Rate for Payer: Healthfirst QHP |
$920.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$644.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$920.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$782.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$644.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$920.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$690.49
|
| Rate for Payer: SOMOS Essential |
$690.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$920.65
|
|
|
PR PHARYNGOSTOMY FSTLJ PHARYNX XTRNL FEEDING
|
Professional
|
Both
|
$3,286.12
|
|
|
Service Code
|
HCPCS 42955
|
| Min. Negotiated Rate |
$612.33 |
| Max. Negotiated Rate |
$1,968.21 |
| Rate for Payer: Cash Price |
$888.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$874.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$787.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$787.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$831.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$874.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$831.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$874.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$874.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$656.07
|
| Rate for Payer: Healthfirst Commercial |
$874.76
|
| Rate for Payer: Healthfirst Essential Plan |
$1,968.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$831.02
|
| Rate for Payer: Healthfirst QHP |
$874.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$612.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$874.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$743.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$612.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$874.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$656.07
|
| Rate for Payer: SOMOS Essential |
$656.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$874.76
|
|
|
PR PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$424.66
|
|
|
Service Code
|
HCPCS 99195
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$236.99 |
| Rate for Payer: Amida Care Medicaid |
$31.45
|
| Rate for Payer: Cash Price |
$114.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$94.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$94.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.00
|
| Rate for Payer: Healthfirst Commercial |
$105.33
|
| Rate for Payer: Healthfirst Essential Plan |
$236.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.06
|
| Rate for Payer: Healthfirst QHP |
$105.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$105.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$89.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.00
|
| Rate for Payer: SOMOS Essential |
$79.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.33
|
|
|
PR PHOTOCHEMOTHERAPY DERMATOSES 4-8 HRS SUPERVISION
|
Professional
|
Both
|
$658.11
|
|
|
Service Code
|
HCPCS 96913
|
| Min. Negotiated Rate |
$123.30 |
| Max. Negotiated Rate |
$396.31 |
| Rate for Payer: Cash Price |
$181.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$176.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$176.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$176.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$176.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.10
|
| Rate for Payer: Healthfirst Commercial |
$176.14
|
| Rate for Payer: Healthfirst Essential Plan |
$396.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.33
|
| Rate for Payer: Healthfirst QHP |
$176.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$176.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$176.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.10
|
| Rate for Payer: SOMOS Essential |
$132.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$176.14
|
|
|
PR PHOTOCHEMOTX PSORALENS&ULTRAVIOLET PUVA
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
HCPCS 96912
|
| Min. Negotiated Rate |
$81.29 |
| Max. Negotiated Rate |
$261.29 |
| Rate for Payer: Cash Price |
$119.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.10
|
| Rate for Payer: Healthfirst Commercial |
$116.13
|
| Rate for Payer: Healthfirst Essential Plan |
$261.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.32
|
| Rate for Payer: Healthfirst QHP |
$116.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.10
|
| Rate for Payer: SOMOS Essential |
$87.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.13
|
|
|
PR PHOTOCHEMOTX TAR&UVB/PETROLATUM/UVB
|
Professional
|
Both
|
$510.02
|
|
|
Service Code
|
HCPCS 96910
|
| Min. Negotiated Rate |
$95.69 |
| Max. Negotiated Rate |
$307.57 |
| Rate for Payer: Cash Price |
$140.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.53
|
| Rate for Payer: Healthfirst Commercial |
$136.70
|
| Rate for Payer: Healthfirst Essential Plan |
$307.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.87
|
| Rate for Payer: Healthfirst QHP |
$136.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.53
|
| Rate for Payer: SOMOS Essential |
$102.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.70
|
|
|
PR PHOTO PATCH TEST SPECIFY NUMBER TSTS
|
Professional
|
Both
|
$28.60
|
|
|
Service Code
|
HCPCS 95052
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$15.37 |
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.12
|
| Rate for Payer: Healthfirst Commercial |
$6.83
|
| Rate for Payer: Healthfirst Essential Plan |
$15.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.49
|
| Rate for Payer: Healthfirst QHP |
$6.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.12
|
| Rate for Payer: SOMOS Essential |
$5.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.83
|
|
|
PR PHOTOPHERESIS EXTRACORPOREAL
|
Professional
|
Both
|
$390.01
|
|
|
Service Code
|
HCPCS 36522
|
| Min. Negotiated Rate |
$74.77 |
| Max. Negotiated Rate |
$240.34 |
| Rate for Payer: Cash Price |
$105.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$101.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.11
|
| Rate for Payer: Healthfirst Commercial |
$106.82
|
| Rate for Payer: Healthfirst Essential Plan |
$240.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$101.48
|
| Rate for Payer: Healthfirst QHP |
$106.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.11
|
| Rate for Payer: SOMOS Essential |
$80.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.82
|
|
|
PR PHOTO TESTS
|
Professional
|
Both
|
$221.10
|
|
|
Service Code
|
HCPCS 95056
|
| Min. Negotiated Rate |
$43.53 |
| Max. Negotiated Rate |
$139.91 |
| Rate for Payer: Cash Price |
$62.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.63
|
| Rate for Payer: Healthfirst Commercial |
$62.18
|
| Rate for Payer: Healthfirst Essential Plan |
$139.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.07
|
| Rate for Payer: Healthfirst QHP |
$62.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.63
|
| Rate for Payer: SOMOS Essential |
$46.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.18
|
|
|
PR PHYS BLD BANK SERV,DEV STD
|
Professional
|
Both
|
$196.25
|
|
|
Service Code
|
HCPCS 86079
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$117.72 |
| Rate for Payer: Cash Price |
$53.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.24
|
| Rate for Payer: Healthfirst Commercial |
$52.32
|
| Rate for Payer: Healthfirst Essential Plan |
$117.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.70
|
| Rate for Payer: Healthfirst QHP |
$52.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.24
|
| Rate for Payer: SOMOS Essential |
$39.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.32
|
|
|
PR PHYS BLD BANK SERV,DIFF XMTCH
|
Professional
|
Both
|
$194.81
|
|
|
Service Code
|
HCPCS 86077
|
| Min. Negotiated Rate |
$36.62 |
| Max. Negotiated Rate |
$117.72 |
| Rate for Payer: Cash Price |
$53.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.24
|
| Rate for Payer: Healthfirst Commercial |
$52.32
|
| Rate for Payer: Healthfirst Essential Plan |
$117.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.70
|
| Rate for Payer: Healthfirst QHP |
$52.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.24
|
| Rate for Payer: SOMOS Essential |
$39.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.32
|
|
|
PR PHYS BLD BANK SERV,XFUSN RX
|
Professional
|
Both
|
$194.81
|
|
|
Service Code
|
HCPCS 86078
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$118.60 |
| Rate for Payer: Cash Price |
$53.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.53
|
| Rate for Payer: Healthfirst Commercial |
$52.71
|
| Rate for Payer: Healthfirst Essential Plan |
$118.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.07
|
| Rate for Payer: Healthfirst QHP |
$52.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.53
|
| Rate for Payer: SOMOS Essential |
$39.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.71
|
|
|
PR PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN
|
Professional
|
Both
|
$138.15
|
|
|
Service Code
|
HCPCS 97750
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$86.06 |
| Rate for Payer: Cash Price |
$38.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.69
|
| Rate for Payer: Healthfirst Commercial |
$38.25
|
| Rate for Payer: Healthfirst Essential Plan |
$86.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.34
|
| Rate for Payer: Healthfirst QHP |
$38.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.69
|
| Rate for Payer: SOMOS Essential |
$28.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.25
|
|
|
PR PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS
|
Professional
|
Both
|
$407.96
|
|
|
Service Code
|
HCPCS 97163
|
| Min. Negotiated Rate |
$78.27 |
| Max. Negotiated Rate |
$251.57 |
| Rate for Payer: Cash Price |
$112.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.86
|
| Rate for Payer: Healthfirst Commercial |
$111.81
|
| Rate for Payer: Healthfirst Essential Plan |
$251.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.22
|
| Rate for Payer: Healthfirst QHP |
$111.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.86
|
| Rate for Payer: SOMOS Essential |
$83.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.81
|
|
|
PR PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS
|
Professional
|
Both
|
$407.96
|
|
|
Service Code
|
HCPCS 97161
|
| Min. Negotiated Rate |
$78.27 |
| Max. Negotiated Rate |
$251.57 |
| Rate for Payer: Cash Price |
$112.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.86
|
| Rate for Payer: Healthfirst Commercial |
$111.81
|
| Rate for Payer: Healthfirst Essential Plan |
$251.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.22
|
| Rate for Payer: Healthfirst QHP |
$111.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.86
|
| Rate for Payer: SOMOS Essential |
$83.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.81
|
|
|
PR PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS
|
Professional
|
Both
|
$407.96
|
|
|
Service Code
|
HCPCS 97162
|
| Min. Negotiated Rate |
$78.27 |
| Max. Negotiated Rate |
$251.57 |
| Rate for Payer: Cash Price |
$112.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.86
|
| Rate for Payer: Healthfirst Commercial |
$111.81
|
| Rate for Payer: Healthfirst Essential Plan |
$251.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.22
|
| Rate for Payer: Healthfirst QHP |
$111.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.86
|
| Rate for Payer: SOMOS Essential |
$83.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.81
|
|
|
PR PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS
|
Professional
|
Both
|
$286.44
|
|
|
Service Code
|
HCPCS 97164
|
| Min. Negotiated Rate |
$54.17 |
| Max. Negotiated Rate |
$174.13 |
| Rate for Payer: Cash Price |
$78.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.04
|
| Rate for Payer: Healthfirst Commercial |
$77.39
|
| Rate for Payer: Healthfirst Essential Plan |
$174.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.52
|
| Rate for Payer: Healthfirst QHP |
$77.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.04
|
| Rate for Payer: SOMOS Essential |
$58.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.39
|
|
|
PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU
|
Professional
|
Both
|
$922.39
|
|
|
Service Code
|
HCPCS 93464
|
| Min. Negotiated Rate |
$121.17 |
| Max. Negotiated Rate |
$551.65 |
| Rate for Payer: Amida Care Medicaid |
$121.17
|
| Rate for Payer: Cash Price |
$251.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$245.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$220.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$220.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$232.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$232.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$183.88
|
| Rate for Payer: Healthfirst Commercial |
$245.18
|
| Rate for Payer: Healthfirst Essential Plan |
$551.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$232.92
|
| Rate for Payer: Healthfirst QHP |
$245.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$171.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$245.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$171.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$183.88
|
| Rate for Payer: SOMOS Essential |
$183.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.18
|
|
|
PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU
|
Professional
|
Both
|
$570.54
|
|
|
Service Code
|
HCPCS 93464 TC
|
| Min. Negotiated Rate |
$103.84 |
| Max. Negotiated Rate |
$333.79 |
| Rate for Payer: Amida Care Medicaid |
$121.17
|
| Rate for Payer: Cash Price |
$155.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$148.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$148.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.26
|
| Rate for Payer: Healthfirst Commercial |
$148.35
|
| Rate for Payer: Healthfirst Essential Plan |
$333.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.93
|
| Rate for Payer: Healthfirst QHP |
$148.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$148.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$126.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$148.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.26
|
| Rate for Payer: SOMOS Essential |
$111.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.35
|
|
|
PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU
|
Professional
|
Both
|
$351.86
|
|
|
Service Code
|
HCPCS 93464 26
|
| Min. Negotiated Rate |
$67.78 |
| Max. Negotiated Rate |
$217.87 |
| Rate for Payer: Amida Care Medicaid |
$121.17
|
| Rate for Payer: Cash Price |
$96.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.62
|
| Rate for Payer: Healthfirst Commercial |
$96.83
|
| Rate for Payer: Healthfirst Essential Plan |
$217.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.99
|
| Rate for Payer: Healthfirst QHP |
$96.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.62
|
| Rate for Payer: SOMOS Essential |
$72.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.83
|
|
|
PR PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX/SESSION
|
Professional
|
Both
|
$446.11
|
|
|
Service Code
|
HCPCS 99183
|
| Min. Negotiated Rate |
$58.17 |
| Max. Negotiated Rate |
$269.21 |
| Rate for Payer: Amida Care Medicaid |
$58.17
|
| Rate for Payer: Cash Price |
$120.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.74
|
| Rate for Payer: Healthfirst Commercial |
$119.65
|
| Rate for Payer: Healthfirst Essential Plan |
$269.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.67
|
| Rate for Payer: Healthfirst QHP |
$119.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.74
|
| Rate for Payer: SOMOS Essential |
$89.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.65
|
|
|
PR PHYS/QHP R&I CPTR MTN ALYS WALK/FUNCJL ACTV REPR
|
Professional
|
Both
|
$443.91
|
|
|
Service Code
|
HCPCS 96004
|
| Min. Negotiated Rate |
$82.17 |
| Max. Negotiated Rate |
$264.11 |
| Rate for Payer: Cash Price |
$119.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.03
|
| Rate for Payer: Healthfirst Commercial |
$117.38
|
| Rate for Payer: Healthfirst Essential Plan |
$264.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.51
|
| Rate for Payer: Healthfirst QHP |
$117.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.03
|
| Rate for Payer: SOMOS Essential |
$88.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.38
|
|
|
PR PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR
|
Professional
|
Both
|
$109.83
|
|
|
Service Code
|
HCPCS 94626
|
| Min. Negotiated Rate |
$14.87 |
| Max. Negotiated Rate |
$63.81 |
| Rate for Payer: Amida Care Medicaid |
$14.87
|
| Rate for Payer: Cash Price |
$30.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.27
|
| Rate for Payer: Healthfirst Commercial |
$28.36
|
| Rate for Payer: Healthfirst Essential Plan |
$63.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.94
|
| Rate for Payer: Healthfirst QHP |
$28.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.27
|
| Rate for Payer: SOMOS Essential |
$21.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.36
|
|
|
PR PHYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR
|
Professional
|
Both
|
$70.42
|
|
|
Service Code
|
HCPCS 94625
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$44.82 |
| Rate for Payer: Amida Care Medicaid |
$10.61
|
| Rate for Payer: Cash Price |
$20.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.94
|
| Rate for Payer: Healthfirst Commercial |
$19.92
|
| Rate for Payer: Healthfirst Essential Plan |
$44.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.92
|
| Rate for Payer: Healthfirst QHP |
$19.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.94
|
| Rate for Payer: SOMOS Essential |
$14.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.92
|
|
