|
PR PSYCHOTHERAPY W/PATIENT 30 MINUTES
|
Professional
|
Both
|
$255.50
|
|
|
Service Code
|
HCPCS 90832
|
| Min. Negotiated Rate |
$25.21 |
| Max. Negotiated Rate |
$169.83 |
| Rate for Payer: Amida Care Medicaid |
$25.21
|
| Rate for Payer: Cash Price |
$73.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.61
|
| Rate for Payer: Healthfirst Commercial |
$75.48
|
| Rate for Payer: Healthfirst Essential Plan |
$169.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.71
|
| Rate for Payer: Healthfirst QHP |
$75.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.61
|
| Rate for Payer: SOMOS Essential |
$56.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.48
|
|
|
PR PSYCHOTHERAPY W/PATIENT 45 MINUTES
|
Professional
|
Both
|
$340.10
|
|
|
Service Code
|
HCPCS 90834
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$223.92 |
| Rate for Payer: Amida Care Medicaid |
$37.79
|
| Rate for Payer: Cash Price |
$97.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$99.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.64
|
| Rate for Payer: Healthfirst Commercial |
$99.52
|
| Rate for Payer: Healthfirst Essential Plan |
$223.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.54
|
| Rate for Payer: Healthfirst QHP |
$99.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.64
|
| Rate for Payer: SOMOS Essential |
$74.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.52
|
|
|
PR PSYCHOTHERAPY W/PATIENT 60 MINUTES
|
Professional
|
Both
|
$498.26
|
|
|
Service Code
|
HCPCS 90837
|
| Min. Negotiated Rate |
$57.05 |
| Max. Negotiated Rate |
$331.79 |
| Rate for Payer: Amida Care Medicaid |
$57.05
|
| Rate for Payer: Cash Price |
$143.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.59
|
| Rate for Payer: Healthfirst Commercial |
$147.46
|
| Rate for Payer: Healthfirst Essential Plan |
$331.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.09
|
| Rate for Payer: Healthfirst QHP |
$147.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.59
|
| Rate for Payer: SOMOS Essential |
$110.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.46
|
|
|
PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN
|
Professional
|
Both
|
$243.11
|
|
|
Service Code
|
HCPCS 90833
|
| Min. Negotiated Rate |
$21.24 |
| Max. Negotiated Rate |
$160.78 |
| Rate for Payer: Amida Care Medicaid |
$21.24
|
| Rate for Payer: Cash Price |
$70.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.59
|
| Rate for Payer: Healthfirst Commercial |
$71.46
|
| Rate for Payer: Healthfirst Essential Plan |
$160.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.89
|
| Rate for Payer: Healthfirst QHP |
$71.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.59
|
| Rate for Payer: SOMOS Essential |
$53.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.46
|
|
|
PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN
|
Professional
|
Both
|
$308.74
|
|
|
Service Code
|
HCPCS 90836
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$204.66 |
| Rate for Payer: Amida Care Medicaid |
$34.76
|
| Rate for Payer: Cash Price |
$88.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.22
|
| Rate for Payer: Healthfirst Commercial |
$90.96
|
| Rate for Payer: Healthfirst Essential Plan |
$204.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.41
|
| Rate for Payer: Healthfirst QHP |
$90.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.22
|
| Rate for Payer: SOMOS Essential |
$68.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.96
|
|
|
PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN
|
Professional
|
Both
|
$410.80
|
|
|
Service Code
|
HCPCS 90838
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$275.00 |
| Rate for Payer: Amida Care Medicaid |
$55.84
|
| Rate for Payer: Cash Price |
$117.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.67
|
| Rate for Payer: Healthfirst Commercial |
$122.22
|
| Rate for Payer: Healthfirst Essential Plan |
$275.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.11
|
| Rate for Payer: Healthfirst QHP |
$122.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$91.67
|
| Rate for Payer: SOMOS Essential |
$91.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.22
|
|
|
PR PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT
|
Professional
|
Both
|
$11.38
|
|
|
Service Code
|
HCPCS 96146
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$6.64 |
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.21
|
| Rate for Payer: Healthfirst Commercial |
$2.95
|
| Rate for Payer: Healthfirst Essential Plan |
$6.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.80
|
| Rate for Payer: Healthfirst QHP |
$2.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.21
|
| Rate for Payer: SOMOS Essential |
$2.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.95
|
|
|
PR PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN
|
Professional
|
Both
|
$68.99
|
|
|
Service Code
|
HCPCS 96137
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$42.28 |
| Rate for Payer: Amida Care Medicaid |
$10.35
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.09
|
| Rate for Payer: Healthfirst Commercial |
$18.79
|
| Rate for Payer: Healthfirst Essential Plan |
$42.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.85
|
| Rate for Payer: Healthfirst QHP |
$18.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.09
|
| Rate for Payer: SOMOS Essential |
$14.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.79
|
|
|
PR PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN
|
Professional
|
Both
|
$146.48
|
|
|
Service Code
|
HCPCS 96138
|
| Min. Negotiated Rate |
$21.08 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Amida Care Medicaid |
$21.08
|
| Rate for Payer: Cash Price |
$40.70
|
| 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 PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN
|
Professional
|
Both
|
$150.82
|
|
|
Service Code
|
HCPCS 96139
|
| Min. Negotiated Rate |
$21.08 |
| Max. Negotiated Rate |
$91.35 |
| Rate for Payer: Amida Care Medicaid |
$21.08
|
| Rate for Payer: Cash Price |
$41.88
|
| 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 PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN
|
Professional
|
Both
|
$91.60
|
|
|
Service Code
|
HCPCS 96136
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$57.28 |
| Rate for Payer: Amida Care Medicaid |
$13.23
|
| Rate for Payer: Cash Price |
$25.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.09
|
| Rate for Payer: Healthfirst Commercial |
$25.46
|
| Rate for Payer: Healthfirst Essential Plan |
$57.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.19
|
| Rate for Payer: Healthfirst QHP |
$25.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.09
|
| Rate for Payer: SOMOS Essential |
$19.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.46
|
|
|
PR PT/CAREGIVER TRAING FOR INITIATION HOME INR MNTR
|
Professional
|
Both
|
$307.06
|
|
|
Service Code
|
HCPCS 93792
|
| Min. Negotiated Rate |
$56.45 |
| Max. Negotiated Rate |
$181.46 |
| Rate for Payer: Cash Price |
$83.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.49
|
| Rate for Payer: Healthfirst Commercial |
$80.65
|
| Rate for Payer: Healthfirst Essential Plan |
$181.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.62
|
| Rate for Payer: Healthfirst QHP |
$80.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.49
|
| Rate for Payer: SOMOS Essential |
$60.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.65
|
|
|
PR PTERYGOMAXILLARY FOSSA SURGERY ANY APPROACH
|
Professional
|
Both
|
$3,502.94
|
|
|
Service Code
|
HCPCS 31040
|
| Min. Negotiated Rate |
$650.73 |
| Max. Negotiated Rate |
$2,091.64 |
| Rate for Payer: Cash Price |
$947.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$929.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$836.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$836.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$883.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$929.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$883.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$929.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$929.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$697.22
|
| Rate for Payer: Healthfirst Commercial |
$929.62
|
| Rate for Payer: Healthfirst Essential Plan |
$2,091.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$883.14
|
| Rate for Payer: Healthfirst QHP |
$929.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$650.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$929.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$790.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$650.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$929.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$697.22
|
| Rate for Payer: SOMOS Essential |
$697.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$929.62
|
|
|
PR PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Professional
|
Both
|
$11.52
|
|
|
Service Code
|
HCPCS 96160
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.62
|
| Rate for Payer: Healthfirst Commercial |
$3.49
|
| Rate for Payer: Healthfirst Essential Plan |
$7.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.32
|
| Rate for Payer: Healthfirst QHP |
$3.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.62
|
| Rate for Payer: SOMOS Essential |
$2.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.49
|
|
|
PR PT-INITIATE SPIROMETRIC RECORDING PHYS/QHP R&I
|
Professional
|
Both
|
$230.02
|
|
|
Service Code
|
HCPCS 94014
|
| Min. Negotiated Rate |
$25.69 |
| Max. Negotiated Rate |
$143.17 |
| Rate for Payer: Amida Care Medicaid |
$25.69
|
| Rate for Payer: Cash Price |
$64.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$63.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.72
|
| Rate for Payer: Healthfirst Commercial |
$63.63
|
| Rate for Payer: Healthfirst Essential Plan |
$143.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.45
|
| Rate for Payer: Healthfirst QHP |
$63.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.72
|
| Rate for Payer: SOMOS Essential |
$47.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.63
|
|
|
PR PULMONARY ARTERY EMBOLECTOMY W/CARD BYPASS
|
Professional
|
Both
|
$11,690.00
|
|
|
Service Code
|
HCPCS 33910
|
| Min. Negotiated Rate |
$2,118.03 |
| Max. Negotiated Rate |
$6,807.96 |
| Rate for Payer: Cash Price |
$3,054.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,025.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,723.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,723.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,874.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,025.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,874.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,025.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,025.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,269.32
|
| Rate for Payer: Healthfirst Commercial |
$3,025.76
|
| Rate for Payer: Healthfirst Essential Plan |
$6,807.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,874.47
|
| Rate for Payer: Healthfirst QHP |
$3,025.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,118.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,025.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,571.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,118.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,025.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,269.32
|
| Rate for Payer: SOMOS Essential |
$2,269.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,025.76
|
|
|
PR PULMONARY ARTERY EMBOLECTOMY W/O CARD BYPASS
|
Professional
|
Both
|
$6,061.51
|
|
|
Service Code
|
HCPCS 33915
|
| Min. Negotiated Rate |
$1,117.61 |
| Max. Negotiated Rate |
$3,592.30 |
| Rate for Payer: Cash Price |
$1,608.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,596.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,436.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,436.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,516.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,596.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,516.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,596.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,596.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,197.43
|
| Rate for Payer: Healthfirst Commercial |
$1,596.58
|
| Rate for Payer: Healthfirst Essential Plan |
$3,592.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,516.75
|
| Rate for Payer: Healthfirst QHP |
$1,596.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,117.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,596.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,357.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,117.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,596.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,197.43
|
| Rate for Payer: SOMOS Essential |
$1,197.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,596.58
|
|
|
PR PULMONARY ENDARTERCOMY W/WO EMBOLECTOMY W/BYPASS
|
Professional
|
Both
|
$18,481.12
|
|
|
Service Code
|
HCPCS 33916
|
| Min. Negotiated Rate |
$3,396.91 |
| Max. Negotiated Rate |
$10,918.64 |
| Rate for Payer: Cash Price |
$4,883.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,852.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,367.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,367.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,610.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,852.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,610.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,852.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,852.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,639.55
|
| Rate for Payer: Healthfirst Commercial |
$4,852.73
|
| Rate for Payer: Healthfirst Essential Plan |
$10,918.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,610.09
|
| Rate for Payer: Healthfirst QHP |
$4,852.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,396.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,852.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,124.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,396.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,852.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,639.55
|
| Rate for Payer: SOMOS Essential |
$3,639.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,852.73
|
|
|
PR PULMONARY STRESS TESTING
|
Professional
|
Both
|
$51.63
|
|
|
Service Code
|
HCPCS 94618 TC
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Amida Care Medicaid |
$22.23
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.23
|
| Rate for Payer: Healthfirst Commercial |
$14.98
|
| Rate for Payer: Healthfirst Essential Plan |
$33.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.23
|
| Rate for Payer: Healthfirst QHP |
$14.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.23
|
| Rate for Payer: SOMOS Essential |
$11.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.98
|
|
|
PR PULMONARY STRESS TESTING
|
Professional
|
Both
|
$138.78
|
|
|
Service Code
|
HCPCS 94618
|
| Min. Negotiated Rate |
$22.23 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Amida Care Medicaid |
$22.23
|
| Rate for Payer: Cash Price |
$38.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.93
|
| Rate for Payer: Healthfirst Commercial |
$38.57
|
| Rate for Payer: Healthfirst Essential Plan |
$86.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.64
|
| Rate for Payer: Healthfirst QHP |
$38.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.93
|
| Rate for Payer: SOMOS Essential |
$28.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.57
|
|
|
PR PULMONARY STRESS TESTING
|
Professional
|
Both
|
$87.15
|
|
|
Service Code
|
HCPCS 94618 26
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$53.08 |
| Rate for Payer: Amida Care Medicaid |
$22.23
|
| Rate for Payer: Cash Price |
$23.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.69
|
| Rate for Payer: Healthfirst Commercial |
$23.59
|
| Rate for Payer: Healthfirst Essential Plan |
$53.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.41
|
| Rate for Payer: Healthfirst QHP |
$23.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.69
|
| Rate for Payer: SOMOS Essential |
$17.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.59
|
|
|
PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$108.71
|
|
|
Service Code
|
HCPCS 11105
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$65.05 |
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.68
|
| Rate for Payer: Healthfirst Commercial |
$28.91
|
| Rate for Payer: Healthfirst Essential Plan |
$65.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.46
|
| Rate for Payer: Healthfirst QHP |
$28.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.68
|
| Rate for Payer: SOMOS Essential |
$21.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.91
|
|
|
PR PUNCH BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$197.44
|
|
|
Service Code
|
HCPCS 11104
|
| Min. Negotiated Rate |
$37.11 |
| Max. Negotiated Rate |
$119.30 |
| Rate for Payer: Cash Price |
$53.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.77
|
| Rate for Payer: Healthfirst Commercial |
$53.02
|
| Rate for Payer: Healthfirst Essential Plan |
$119.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.37
|
| Rate for Payer: Healthfirst QHP |
$53.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.77
|
| Rate for Payer: SOMOS Essential |
$39.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.02
|
|
|
PR PUNCH GRAFT HAIR TRANSPLANT 1-15 PUNCH GRAFTS
|
Professional
|
Both
|
$1,111.50
|
|
|
Service Code
|
HCPCS 15775
|
| Min. Negotiated Rate |
$208.46 |
| Max. Negotiated Rate |
$670.05 |
| Rate for Payer: Cash Price |
$298.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$297.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$268.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$268.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$282.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$297.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$282.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$297.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$223.35
|
| Rate for Payer: Healthfirst Commercial |
$297.80
|
| Rate for Payer: Healthfirst Essential Plan |
$670.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$282.91
|
| Rate for Payer: Healthfirst QHP |
$297.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$208.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$297.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$253.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$208.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$297.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$223.35
|
| Rate for Payer: SOMOS Essential |
$223.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$297.80
|
|
|
PR PUNCH GRAFT HAIR TRANSPLANT >15 PUNCH GRAFTS
|
Professional
|
Both
|
$1,515.64
|
|
|
Service Code
|
HCPCS 15776
|
| Min. Negotiated Rate |
$285.36 |
| Max. Negotiated Rate |
$917.21 |
| Rate for Payer: Cash Price |
$409.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$407.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$366.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$366.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$387.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$407.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$387.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$407.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$407.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$305.74
|
| Rate for Payer: Healthfirst Commercial |
$407.65
|
| Rate for Payer: Healthfirst Essential Plan |
$917.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$387.27
|
| Rate for Payer: Healthfirst QHP |
$407.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$285.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$407.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$346.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$285.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$407.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$305.74
|
| Rate for Payer: SOMOS Essential |
$305.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$407.65
|
|
