|
PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$2,128.42
|
|
|
Service Code
|
HCPCS 95810 TC
|
| Min. Negotiated Rate |
$419.38 |
| Max. Negotiated Rate |
$1,348.00 |
| Rate for Payer: Amida Care Medicaid |
$654.30
|
| Rate for Payer: Cash Price |
$602.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$599.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$539.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$539.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$569.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$599.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$569.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$599.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$599.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$449.33
|
| Rate for Payer: Healthfirst Commercial |
$599.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,348.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.15
|
| Rate for Payer: Healthfirst QHP |
$599.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$419.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$599.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$509.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$419.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$599.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$449.33
|
| Rate for Payer: SOMOS Essential |
$449.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$599.11
|
|
|
PR POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$3,594.57
|
|
|
Service Code
|
HCPCS 95782 TC
|
| Min. Negotiated Rate |
$599.19 |
| Max. Negotiated Rate |
$2,245.05 |
| Rate for Payer: Amida Care Medicaid |
$599.19
|
| Rate for Payer: Cash Price |
$1,017.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$997.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$898.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$947.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$997.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$947.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$997.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$997.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$748.35
|
| Rate for Payer: Healthfirst Commercial |
$997.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,245.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$947.91
|
| Rate for Payer: Healthfirst QHP |
$997.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$698.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$997.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$848.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$698.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$997.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$748.35
|
| Rate for Payer: SOMOS Essential |
$748.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$997.80
|
|
|
PR POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$4,077.26
|
|
|
Service Code
|
HCPCS 95782
|
| Min. Negotiated Rate |
$599.19 |
| Max. Negotiated Rate |
$2,538.41 |
| Rate for Payer: Amida Care Medicaid |
$599.19
|
| Rate for Payer: Cash Price |
$1,150.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,128.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,015.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,015.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,071.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,128.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,071.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,128.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,128.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$846.13
|
| Rate for Payer: Healthfirst Commercial |
$1,128.18
|
| Rate for Payer: Healthfirst Essential Plan |
$2,538.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,071.77
|
| Rate for Payer: Healthfirst QHP |
$1,128.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$789.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,128.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$958.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$789.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,128.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$846.13
|
| Rate for Payer: SOMOS Essential |
$846.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,128.18
|
|
|
PR POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$482.65
|
|
|
Service Code
|
HCPCS 95782 26
|
| Min. Negotiated Rate |
$91.27 |
| Max. Negotiated Rate |
$599.19 |
| Rate for Payer: Amida Care Medicaid |
$599.19
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.78
|
| Rate for Payer: Healthfirst Commercial |
$130.38
|
| Rate for Payer: Healthfirst Essential Plan |
$293.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$123.86
|
| Rate for Payer: Healthfirst QHP |
$130.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.78
|
| Rate for Payer: SOMOS Essential |
$97.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.38
|
|
|
PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$482.37
|
|
|
Service Code
|
HCPCS 95811 26
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$719.37 |
| Rate for Payer: Amida Care Medicaid |
$719.37
|
| Rate for Payer: Cash Price |
$132.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.59
|
| Rate for Payer: Healthfirst Commercial |
$131.46
|
| Rate for Payer: Healthfirst Essential Plan |
$295.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.89
|
| Rate for Payer: Healthfirst QHP |
$131.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.59
|
| Rate for Payer: SOMOS Essential |
$98.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.46
|
|
|
PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$2,716.77
|
|
|
Service Code
|
HCPCS 95811
|
| Min. Negotiated Rate |
$531.51 |
| Max. Negotiated Rate |
$1,708.42 |
| Rate for Payer: Amida Care Medicaid |
$719.37
|
| Rate for Payer: Cash Price |
$763.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$759.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$683.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$683.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$721.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$759.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$721.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$759.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$759.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$569.48
|
| Rate for Payer: Healthfirst Commercial |
$759.30
|
| Rate for Payer: Healthfirst Essential Plan |
$1,708.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$721.34
|
| Rate for Payer: Healthfirst QHP |
$759.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$531.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$759.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$645.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$531.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$759.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$569.48
|
| Rate for Payer: SOMOS Essential |
$569.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$759.30
|
|
|
PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$2,234.40
|
|
|
Service Code
|
HCPCS 95811 TC
|
| Min. Negotiated Rate |
$439.49 |
| Max. Negotiated Rate |
$1,412.64 |
| Rate for Payer: Amida Care Medicaid |
$719.37
|
| Rate for Payer: Cash Price |
$630.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$627.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$565.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$565.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$627.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$627.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$627.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$470.88
|
| Rate for Payer: Healthfirst Commercial |
$627.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,412.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$596.45
|
| Rate for Payer: Healthfirst QHP |
$627.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$439.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$627.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$533.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$439.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$627.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$470.88
|
| Rate for Payer: SOMOS Essential |
$470.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$627.84
|
|
|
PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM
|
Professional
|
Both
|
$3,791.38
|
|
|
Service Code
|
HCPCS 95783 TC
|
| Min. Negotiated Rate |
$737.20 |
| Max. Negotiated Rate |
$2,369.57 |
| Rate for Payer: Amida Care Medicaid |
$816.61
|
| Rate for Payer: Cash Price |
$1,075.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,053.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$947.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$947.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,000.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,053.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,000.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,053.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,053.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$789.86
|
| Rate for Payer: Healthfirst Commercial |
$1,053.14
|
| Rate for Payer: Healthfirst Essential Plan |
$2,369.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,000.48
|
| Rate for Payer: Healthfirst QHP |
$1,053.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$737.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,053.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$895.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$737.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,053.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$789.86
|
| Rate for Payer: SOMOS Essential |
$789.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,053.14
|
|
|
PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM
|
Professional
|
Both
|
$4,319.81
|
|
|
Service Code
|
HCPCS 95783
|
| Min. Negotiated Rate |
$816.61 |
| Max. Negotiated Rate |
$2,689.13 |
| Rate for Payer: Amida Care Medicaid |
$816.61
|
| Rate for Payer: Cash Price |
$1,220.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,195.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,075.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,075.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,135.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,195.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,135.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,195.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,195.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$896.38
|
| Rate for Payer: Healthfirst Commercial |
$1,195.17
|
| Rate for Payer: Healthfirst Essential Plan |
$2,689.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,135.41
|
| Rate for Payer: Healthfirst QHP |
$1,195.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$836.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,195.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,015.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$836.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,195.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$896.38
|
| Rate for Payer: SOMOS Essential |
$896.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,195.17
|
|
|
PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM
|
Professional
|
Both
|
$528.43
|
|
|
Service Code
|
HCPCS 95783 26
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$816.61 |
| Rate for Payer: Amida Care Medicaid |
$816.61
|
| Rate for Payer: Cash Price |
$145.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.52
|
| Rate for Payer: Healthfirst Commercial |
$142.03
|
| Rate for Payer: Healthfirst Essential Plan |
$319.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.93
|
| Rate for Payer: Healthfirst QHP |
$142.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$120.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.52
|
| Rate for Payer: SOMOS Essential |
$106.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.03
|
|
|
PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND
|
Professional
|
Both
|
$324.91
|
|
|
Service Code
|
HCPCS 95808 26
|
| Min. Negotiated Rate |
$61.13 |
| Max. Negotiated Rate |
$533.69 |
| Rate for Payer: Amida Care Medicaid |
$533.69
|
| Rate for Payer: Cash Price |
$89.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.50
|
| Rate for Payer: Healthfirst Commercial |
$87.33
|
| Rate for Payer: Healthfirst Essential Plan |
$196.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.96
|
| Rate for Payer: Healthfirst QHP |
$87.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.50
|
| Rate for Payer: SOMOS Essential |
$65.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.33
|
|
|
PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND
|
Professional
|
Both
|
$2,025.21
|
|
|
Service Code
|
HCPCS 95808 TC
|
| Min. Negotiated Rate |
$336.89 |
| Max. Negotiated Rate |
$1,082.86 |
| Rate for Payer: Amida Care Medicaid |
$533.69
|
| Rate for Payer: Cash Price |
$511.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$481.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$433.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$433.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$457.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$481.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$457.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$481.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$481.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$360.95
|
| Rate for Payer: Healthfirst Commercial |
$481.27
|
| Rate for Payer: Healthfirst Essential Plan |
$1,082.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$457.21
|
| Rate for Payer: Healthfirst QHP |
$481.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$336.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$481.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$409.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$336.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$481.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$360.95
|
| Rate for Payer: SOMOS Essential |
$360.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$481.27
|
|
|
PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND
|
Professional
|
Both
|
$2,350.11
|
|
|
Service Code
|
HCPCS 95808
|
| Min. Negotiated Rate |
$398.02 |
| Max. Negotiated Rate |
$1,279.35 |
| Rate for Payer: Amida Care Medicaid |
$533.69
|
| Rate for Payer: Cash Price |
$600.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$568.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$511.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$511.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$540.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$568.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$540.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$568.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$568.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$426.45
|
| Rate for Payer: Healthfirst Commercial |
$568.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,279.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$540.17
|
| Rate for Payer: Healthfirst QHP |
$568.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$398.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$568.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$483.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$398.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$568.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$426.45
|
| Rate for Payer: SOMOS Essential |
$426.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$568.60
|
|
|
PR PORTOENETEROSTOMY
|
Professional
|
Both
|
$7,858.38
|
|
|
Service Code
|
HCPCS 47701
|
| Min. Negotiated Rate |
$1,448.89 |
| Max. Negotiated Rate |
$4,657.16 |
| Rate for Payer: Cash Price |
$2,090.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,069.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,862.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,862.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,966.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,069.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,966.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,069.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,069.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,552.39
|
| Rate for Payer: Healthfirst Commercial |
$2,069.85
|
| Rate for Payer: Healthfirst Essential Plan |
$4,657.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,966.36
|
| Rate for Payer: Healthfirst QHP |
$2,069.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,448.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,069.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,759.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,448.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,069.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,552.39
|
| Rate for Payer: SOMOS Essential |
$1,552.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,069.85
|
|
|
PR POSITIONAL NYSTAGMUS TEST
|
Professional
|
Both
|
$117.36
|
|
|
Service Code
|
HCPCS 92542
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$71.44 |
| Rate for Payer: Amida Care Medicaid |
$47.25
|
| Rate for Payer: Cash Price |
$32.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.81
|
| Rate for Payer: Healthfirst Commercial |
$31.75
|
| Rate for Payer: Healthfirst Essential Plan |
$71.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.16
|
| Rate for Payer: Healthfirst QHP |
$31.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.81
|
| Rate for Payer: SOMOS Essential |
$23.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.75
|
|
|
PR POSITIONAL NYSTAGMUS TEST
|
Professional
|
Both
|
$97.37
|
|
|
Service Code
|
HCPCS 92542 26
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$60.44 |
| Rate for Payer: Amida Care Medicaid |
$47.25
|
| Rate for Payer: Cash Price |
$26.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.14
|
| Rate for Payer: Healthfirst Commercial |
$26.86
|
| Rate for Payer: Healthfirst Essential Plan |
$60.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.52
|
| Rate for Payer: Healthfirst QHP |
$26.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.14
|
| Rate for Payer: SOMOS Essential |
$20.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.86
|
|
|
PR POSITIONAL NYSTAGMUS TEST
|
Professional
|
Both
|
$19.99
|
|
|
Service Code
|
HCPCS 92542 TC
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Amida Care Medicaid |
$47.25
|
| Rate for Payer: Cash Price |
$5.34
|
| 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 POST-CATARACT LASER SURGERY
|
Professional
|
Both
|
$1,290.24
|
|
|
Service Code
|
HCPCS 66821
|
| Min. Negotiated Rate |
$244.63 |
| Max. Negotiated Rate |
$786.31 |
| Rate for Payer: Cash Price |
$355.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$349.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$314.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$314.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$332.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$349.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$332.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$349.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$349.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$262.10
|
| Rate for Payer: Healthfirst Commercial |
$349.47
|
| Rate for Payer: Healthfirst Essential Plan |
$786.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$332.00
|
| Rate for Payer: Healthfirst QHP |
$349.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$244.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$349.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$297.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$244.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$349.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$262.10
|
| Rate for Payer: SOMOS Essential |
$262.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$349.47
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$2,680.65
|
|
|
Service Code
|
HCPCS 57250
|
| Min. Negotiated Rate |
$499.40 |
| Max. Negotiated Rate |
$1,605.22 |
| Rate for Payer: Cash Price |
$723.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$713.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$642.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$642.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$677.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$713.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$677.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$713.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$713.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$535.07
|
| Rate for Payer: Healthfirst Commercial |
$713.43
|
| Rate for Payer: Healthfirst Essential Plan |
$1,605.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$677.76
|
| Rate for Payer: Healthfirst QHP |
$713.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$499.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$713.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$606.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$499.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$713.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$535.07
|
| Rate for Payer: SOMOS Essential |
$535.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$713.43
|
|
|
PR POST-D/C CARE PLAN OVERS 30M
|
Professional
|
Both
|
$308.98
|
|
|
Service Code
|
HCPCS G2014
|
| Min. Negotiated Rate |
$58.11 |
| Max. Negotiated Rate |
$186.77 |
| Rate for Payer: Cash Price |
$84.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.26
|
| Rate for Payer: Healthfirst Commercial |
$83.01
|
| Rate for Payer: Healthfirst Essential Plan |
$186.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.86
|
| Rate for Payer: Healthfirst QHP |
$83.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.26
|
| Rate for Payer: SOMOS Essential |
$62.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.01
|
|
|
PR POST-D/C CARE PLAN OVERS 60M
|
Professional
|
Both
|
$430.50
|
|
|
Service Code
|
HCPCS G2015
|
| Min. Negotiated Rate |
$81.26 |
| Max. Negotiated Rate |
$261.18 |
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.06
|
| Rate for Payer: Healthfirst Commercial |
$116.08
|
| Rate for Payer: Healthfirst Essential Plan |
$261.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.28
|
| Rate for Payer: Healthfirst QHP |
$116.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.06
|
| Rate for Payer: SOMOS Essential |
$87.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.08
|
|
|
PR POST-D/C H VST EXT PT 20 M
|
Professional
|
Both
|
$190.82
|
|
|
Service Code
|
HCPCS G2006
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$118.89 |
| Rate for Payer: Cash Price |
$53.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.63
|
| Rate for Payer: Healthfirst Commercial |
$52.84
|
| Rate for Payer: Healthfirst Essential Plan |
$118.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.20
|
| Rate for Payer: Healthfirst QHP |
$52.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.63
|
| Rate for Payer: SOMOS Essential |
$39.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.84
|
|
|
PR POST-D/C H VST EXT PT 30 M
|
Professional
|
Both
|
$313.60
|
|
|
Service Code
|
HCPCS G2007
|
| Min. Negotiated Rate |
$60.37 |
| Max. Negotiated Rate |
$194.04 |
| Rate for Payer: Cash Price |
$86.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.68
|
| Rate for Payer: Healthfirst Commercial |
$86.24
|
| Rate for Payer: Healthfirst Essential Plan |
$194.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.93
|
| Rate for Payer: Healthfirst QHP |
$86.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.68
|
| Rate for Payer: SOMOS Essential |
$64.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.24
|
|
|
PR POST-D/C H VST EXT PT 45 M
|
Professional
|
Both
|
$505.09
|
|
|
Service Code
|
HCPCS G2008
|
| Min. Negotiated Rate |
$95.44 |
| Max. Negotiated Rate |
$306.79 |
| Rate for Payer: Cash Price |
$138.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.26
|
| Rate for Payer: Healthfirst Commercial |
$136.35
|
| Rate for Payer: Healthfirst Essential Plan |
$306.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.53
|
| Rate for Payer: Healthfirst QHP |
$136.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.26
|
| Rate for Payer: SOMOS Essential |
$102.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.35
|
|
|
PR POST-D/C H VST EXT PT 60 M
|
Professional
|
Both
|
$716.42
|
|
|
Service Code
|
HCPCS G2009
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$432.07 |
| Rate for Payer: Cash Price |
$195.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$182.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.02
|
| Rate for Payer: Healthfirst Commercial |
$192.03
|
| Rate for Payer: Healthfirst Essential Plan |
$432.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$182.43
|
| Rate for Payer: Healthfirst QHP |
$192.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$192.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$163.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.02
|
| Rate for Payer: SOMOS Essential |
$144.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.03
|
|
