|
PR PREDNISOLONE ORAL PER 5 MG
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS J7510
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: Cash Price |
$0.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.17
|
| Rate for Payer: Healthfirst Commercial |
$0.23
|
| Rate for Payer: Healthfirst Essential Plan |
$0.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.22
|
| Rate for Payer: Healthfirst QHP |
$0.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.17
|
| Rate for Payer: SOMOS Essential |
$0.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
PR PREPARATION MOULAGE CUSTOM BREAST IMPLANT
|
Professional
|
Both
|
$618.70
|
|
|
Service Code
|
HCPCS 19396
|
| Min. Negotiated Rate |
$116.75 |
| Max. Negotiated Rate |
$375.28 |
| Rate for Payer: Cash Price |
$167.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$166.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$166.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$166.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.09
|
| Rate for Payer: Healthfirst Commercial |
$166.79
|
| Rate for Payer: Healthfirst Essential Plan |
$375.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$158.45
|
| Rate for Payer: Healthfirst QHP |
$166.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$166.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$166.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$125.09
|
| Rate for Payer: SOMOS Essential |
$125.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.79
|
|
|
PR PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA
|
Professional
|
Both
|
$2,057.69
|
|
|
Service Code
|
HCPCS 49013
|
| Min. Negotiated Rate |
$378.84 |
| Max. Negotiated Rate |
$1,217.70 |
| Rate for Payer: Cash Price |
$545.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$541.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$487.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$487.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$514.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$541.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$514.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$541.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$541.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$405.90
|
| Rate for Payer: Healthfirst Commercial |
$541.20
|
| Rate for Payer: Healthfirst Essential Plan |
$1,217.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$514.14
|
| Rate for Payer: Healthfirst QHP |
$541.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$378.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$541.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$460.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$378.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$541.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$405.90
|
| Rate for Payer: SOMOS Essential |
$405.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$541.20
|
|
|
PR PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN
|
Professional
|
Both
|
$14.56
|
|
|
Service Code
|
HCPCS 95165
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Amida Care Medicaid |
$2.53
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.89
|
| Rate for Payer: Healthfirst Commercial |
$3.85
|
| Rate for Payer: Healthfirst Essential Plan |
$8.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.66
|
| Rate for Payer: Healthfirst QHP |
$3.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.89
|
| Rate for Payer: SOMOS Essential |
$2.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.85
|
|
|
PR PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT
|
Professional
|
Both
|
$13.13
|
|
|
Service Code
|
HCPCS 95145
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Amida Care Medicaid |
$1.76
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.89
|
| Rate for Payer: Healthfirst Commercial |
$3.85
|
| Rate for Payer: Healthfirst Essential Plan |
$8.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.66
|
| Rate for Payer: Healthfirst QHP |
$3.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.89
|
| Rate for Payer: SOMOS Essential |
$2.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.85
|
|
|
PR PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT
|
Professional
|
Both
|
$13.13
|
|
|
Service Code
|
HCPCS 95146
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Amida Care Medicaid |
$1.76
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.89
|
| Rate for Payer: Healthfirst Commercial |
$3.85
|
| Rate for Payer: Healthfirst Essential Plan |
$8.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.66
|
| Rate for Payer: Healthfirst QHP |
$3.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.89
|
| Rate for Payer: SOMOS Essential |
$2.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.85
|
|
|
PR PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 3 INSECT
|
Professional
|
Both
|
$13.13
|
|
|
Service Code
|
HCPCS 95147
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Amida Care Medicaid |
$1.76
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.89
|
| Rate for Payer: Healthfirst Commercial |
$3.85
|
| Rate for Payer: Healthfirst Essential Plan |
$8.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.66
|
| Rate for Payer: Healthfirst QHP |
$3.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.89
|
| Rate for Payer: SOMOS Essential |
$2.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.85
|
|
|
PR PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT
|
Professional
|
Both
|
$13.13
|
|
|
Service Code
|
HCPCS 95148
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Amida Care Medicaid |
$1.76
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.89
|
| Rate for Payer: Healthfirst Commercial |
$3.85
|
| Rate for Payer: Healthfirst Essential Plan |
$8.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.66
|
| Rate for Payer: Healthfirst QHP |
$3.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.89
|
| Rate for Payer: SOMOS Essential |
$2.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.85
|
|
|
PR PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT
|
Professional
|
Both
|
$13.13
|
|
|
Service Code
|
HCPCS 95149
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Amida Care Medicaid |
$1.76
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.89
|
| Rate for Payer: Healthfirst Commercial |
$3.85
|
| Rate for Payer: Healthfirst Essential Plan |
$8.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.66
|
| Rate for Payer: Healthfirst QHP |
$3.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.89
|
| Rate for Payer: SOMOS Essential |
$2.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.85
|
|
|
PR PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE
|
Professional
|
Both
|
$13.13
|
|
|
Service Code
|
HCPCS 95170
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Amida Care Medicaid |
$1.76
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.89
|
| Rate for Payer: Healthfirst Commercial |
$3.85
|
| Rate for Payer: Healthfirst Essential Plan |
$8.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.66
|
| Rate for Payer: Healthfirst QHP |
$3.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.89
|
| Rate for Payer: SOMOS Essential |
$2.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.85
|
|
|
PR PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO
|
Professional
|
Both
|
$14.56
|
|
|
Service Code
|
HCPCS 95144
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Amida Care Medicaid |
$1.76
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.89
|
| Rate for Payer: Healthfirst Commercial |
$3.85
|
| Rate for Payer: Healthfirst Essential Plan |
$8.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.66
|
| Rate for Payer: Healthfirst QHP |
$3.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.89
|
| Rate for Payer: SOMOS Essential |
$2.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.85
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT
|
Professional
|
Both
|
$1,106.70
|
|
|
Service Code
|
HCPCS 15004
|
| Min. Negotiated Rate |
$208.35 |
| Max. Negotiated Rate |
$669.69 |
| Rate for Payer: Cash Price |
$297.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$297.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$267.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$267.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$282.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$297.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$282.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$297.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$223.23
|
| Rate for Payer: Healthfirst Commercial |
$297.64
|
| Rate for Payer: Healthfirst Essential Plan |
$669.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$282.76
|
| Rate for Payer: Healthfirst QHP |
$297.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$208.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$297.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$252.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$208.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$297.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$223.23
|
| Rate for Payer: SOMOS Essential |
$223.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$297.64
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT
|
Professional
|
Both
|
$391.58
|
|
|
Service Code
|
HCPCS 15005
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$235.94 |
| Rate for Payer: Cash Price |
$105.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$94.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$94.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.64
|
| Rate for Payer: Healthfirst Commercial |
$104.86
|
| Rate for Payer: Healthfirst Essential Plan |
$235.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$99.62
|
| Rate for Payer: Healthfirst QHP |
$104.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$89.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.64
|
| Rate for Payer: SOMOS Essential |
$78.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.86
|
|
|
PR PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT
|
Professional
|
Both
|
$951.27
|
|
|
Service Code
|
HCPCS 15002
|
| Min. Negotiated Rate |
$178.63 |
| Max. Negotiated Rate |
$574.18 |
| Rate for Payer: Cash Price |
$255.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$255.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$229.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$229.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$255.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.39
|
| Rate for Payer: Healthfirst Commercial |
$255.19
|
| Rate for Payer: Healthfirst Essential Plan |
$574.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.43
|
| Rate for Payer: Healthfirst QHP |
$255.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$178.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$255.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$216.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$178.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$255.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.39
|
| Rate for Payer: SOMOS Essential |
$191.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.19
|
|
|
PR PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT
|
Professional
|
Both
|
$201.22
|
|
|
Service Code
|
HCPCS 15003
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$117.09 |
| Rate for Payer: Cash Price |
$53.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.03
|
| Rate for Payer: Healthfirst Commercial |
$52.04
|
| Rate for Payer: Healthfirst Essential Plan |
$117.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.44
|
| Rate for Payer: Healthfirst QHP |
$52.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.03
|
| Rate for Payer: SOMOS Essential |
$39.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.04
|
|
|
PR PREP TUMOR CAVITY IORT W/PARTIAL MASTECTOMY
|
Professional
|
Both
|
$740.67
|
|
|
Service Code
|
HCPCS 19294
|
| Min. Negotiated Rate |
$136.75 |
| Max. Negotiated Rate |
$439.54 |
| Rate for Payer: Cash Price |
$196.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$195.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$175.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$195.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.51
|
| Rate for Payer: Healthfirst Commercial |
$195.35
|
| Rate for Payer: Healthfirst Essential Plan |
$439.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.58
|
| Rate for Payer: Healthfirst QHP |
$195.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$195.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$195.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.51
|
| Rate for Payer: SOMOS Essential |
$146.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.35
|
|
|
PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT
|
Professional
|
Both
|
$40.11
|
|
|
Service Code
|
HCPCS 94640
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$21.49 |
| Rate for Payer: Amida Care Medicaid |
$7.42
|
| Rate for Payer: Cash Price |
$9.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.16
|
| Rate for Payer: Healthfirst Commercial |
$9.55
|
| Rate for Payer: Healthfirst Essential Plan |
$21.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.07
|
| Rate for Payer: Healthfirst QHP |
$9.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.16
|
| Rate for Payer: SOMOS Essential |
$7.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.55
|
|
|
PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP
|
Professional
|
Both
|
$122.82
|
|
|
Service Code
|
HCPCS 93279 26
|
| Min. Negotiated Rate |
$23.33 |
| Max. Negotiated Rate |
$74.99 |
| Rate for Payer: Amida Care Medicaid |
$44.08
|
| Rate for Payer: Cash Price |
$33.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.00
|
| Rate for Payer: Healthfirst Commercial |
$33.33
|
| Rate for Payer: Healthfirst Essential Plan |
$74.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.66
|
| Rate for Payer: Healthfirst QHP |
$33.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.00
|
| Rate for Payer: SOMOS Essential |
$25.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.33
|
|
|
PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP
|
Professional
|
Both
|
$160.86
|
|
|
Service Code
|
HCPCS 93279 TC
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$93.96 |
| Rate for Payer: Amida Care Medicaid |
$44.08
|
| Rate for Payer: Cash Price |
$43.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.32
|
| Rate for Payer: Healthfirst Commercial |
$41.76
|
| Rate for Payer: Healthfirst Essential Plan |
$93.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.67
|
| Rate for Payer: Healthfirst QHP |
$41.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.32
|
| Rate for Payer: SOMOS Essential |
$31.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.76
|
|
|
PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP
|
Professional
|
Both
|
$283.68
|
|
|
Service Code
|
HCPCS 93279
|
| Min. Negotiated Rate |
$44.08 |
| Max. Negotiated Rate |
$168.95 |
| Rate for Payer: Amida Care Medicaid |
$44.08
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.32
|
| Rate for Payer: Healthfirst Commercial |
$75.09
|
| Rate for Payer: Healthfirst Essential Plan |
$168.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.34
|
| Rate for Payer: Healthfirst QHP |
$75.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.32
|
| Rate for Payer: SOMOS Essential |
$56.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.09
|
|
|
PR PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM
|
Professional
|
Both
|
$167.72
|
|
|
Service Code
|
HCPCS 93260 26
|
| Min. Negotiated Rate |
$31.03 |
| Max. Negotiated Rate |
$99.74 |
| Rate for Payer: Amida Care Medicaid |
$43.16
|
| Rate for Payer: Cash Price |
$44.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.25
|
| Rate for Payer: Healthfirst Commercial |
$44.33
|
| Rate for Payer: Healthfirst Essential Plan |
$99.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.11
|
| Rate for Payer: Healthfirst QHP |
$44.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.25
|
| Rate for Payer: SOMOS Essential |
$33.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.33
|
|
|
PR PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM
|
Professional
|
Both
|
$152.25
|
|
|
Service Code
|
HCPCS 93260 TC
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Amida Care Medicaid |
$43.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.45
|
| Rate for Payer: Healthfirst Commercial |
$40.60
|
| Rate for Payer: Healthfirst Essential Plan |
$91.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.57
|
| Rate for Payer: Healthfirst QHP |
$40.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.45
|
| Rate for Payer: SOMOS Essential |
$30.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.60
|
|
|
PR PRGRMG DEV EVAL IMPLANTABLE SUBQ LEAD DFB SYSTEM
|
Professional
|
Both
|
$319.97
|
|
|
Service Code
|
HCPCS 93260
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$191.09 |
| Rate for Payer: Amida Care Medicaid |
$43.16
|
| Rate for Payer: Cash Price |
$85.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.70
|
| Rate for Payer: Healthfirst Commercial |
$84.93
|
| Rate for Payer: Healthfirst Essential Plan |
$191.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.68
|
| Rate for Payer: Healthfirst QHP |
$84.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.70
|
| Rate for Payer: SOMOS Essential |
$63.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.93
|
|
|
PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$100.80
|
|
|
Service Code
|
HCPCS 93285 26
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$60.55 |
| Rate for Payer: Amida Care Medicaid |
$38.12
|
| Rate for Payer: Cash Price |
$27.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.18
|
| Rate for Payer: Healthfirst Commercial |
$26.91
|
| Rate for Payer: Healthfirst Essential Plan |
$60.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.56
|
| Rate for Payer: Healthfirst QHP |
$26.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.18
|
| Rate for Payer: SOMOS Essential |
$20.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.91
|
|
|
PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$155.12
|
|
|
Service Code
|
HCPCS 93285 TC
|
| Min. Negotiated Rate |
$27.87 |
| Max. Negotiated Rate |
$89.59 |
| Rate for Payer: Amida Care Medicaid |
$38.12
|
| Rate for Payer: Cash Price |
$41.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.86
|
| Rate for Payer: Healthfirst Commercial |
$39.82
|
| Rate for Payer: Healthfirst Essential Plan |
$89.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.83
|
| Rate for Payer: Healthfirst QHP |
$39.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.86
|
| Rate for Payer: SOMOS Essential |
$29.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.82
|
|
