|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Professional
|
Both
|
$412.97
|
|
|
Service Code
|
HCPCS 10160
|
| Min. Negotiated Rate |
$78.36 |
| Max. Negotiated Rate |
$251.89 |
| Rate for Payer: Cash Price |
$112.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.96
|
| Rate for Payer: Healthfirst Commercial |
$111.95
|
| Rate for Payer: Healthfirst Essential Plan |
$251.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.35
|
| Rate for Payer: Healthfirst QHP |
$111.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.96
|
| Rate for Payer: SOMOS Essential |
$83.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.95
|
|
|
PR PUNCTURE ASPIRATION CYST BREAST EACH ADDL CYST
|
Professional
|
Both
|
$85.12
|
|
|
Service Code
|
HCPCS 19001
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$51.21 |
| Rate for Payer: Cash Price |
$23.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.07
|
| Rate for Payer: Healthfirst Commercial |
$22.76
|
| Rate for Payer: Healthfirst Essential Plan |
$51.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.62
|
| Rate for Payer: Healthfirst QHP |
$22.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.07
|
| Rate for Payer: SOMOS Essential |
$17.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.76
|
|
|
PR PUNCTURE ASPIRATION CYST OF BREAST
|
Professional
|
Both
|
$179.87
|
|
|
Service Code
|
HCPCS 19000
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$108.88 |
| Rate for Payer: Cash Price |
$47.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.29
|
| Rate for Payer: Healthfirst Commercial |
$48.39
|
| Rate for Payer: Healthfirst Essential Plan |
$108.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.97
|
| Rate for Payer: Healthfirst QHP |
$48.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.29
|
| Rate for Payer: SOMOS Essential |
$36.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.39
|
|
|
PR PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX
|
Professional
|
Both
|
$247.10
|
|
|
Service Code
|
HCPCS 61070
|
| Min. Negotiated Rate |
$45.77 |
| Max. Negotiated Rate |
$147.13 |
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.04
|
| Rate for Payer: Healthfirst Commercial |
$65.39
|
| Rate for Payer: Healthfirst Essential Plan |
$147.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.12
|
| Rate for Payer: Healthfirst QHP |
$65.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.04
|
| Rate for Payer: SOMOS Essential |
$49.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.39
|
|
|
PR PURE TONE AUDIOMETRY AIR & BONE
|
Professional
|
Both
|
$188.16
|
|
|
Service Code
|
HCPCS 92553
|
| Min. Negotiated Rate |
$15.85 |
| Max. Negotiated Rate |
$127.15 |
| Rate for Payer: Amida Care Medicaid |
$15.85
|
| Rate for Payer: Cash Price |
$54.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.38
|
| Rate for Payer: Healthfirst Commercial |
$56.51
|
| Rate for Payer: Healthfirst Essential Plan |
$127.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.68
|
| Rate for Payer: Healthfirst QHP |
$56.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.38
|
| Rate for Payer: SOMOS Essential |
$42.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.51
|
|
|
PR PURE TONE AUDIOMETRY AIR ONLY
|
Professional
|
Both
|
$153.69
|
|
|
Service Code
|
HCPCS 92552
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$105.32 |
| Rate for Payer: Amida Care Medicaid |
$11.53
|
| Rate for Payer: Cash Price |
$45.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.11
|
| Rate for Payer: Healthfirst Commercial |
$46.81
|
| Rate for Payer: Healthfirst Essential Plan |
$105.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.47
|
| Rate for Payer: Healthfirst QHP |
$46.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.11
|
| Rate for Payer: SOMOS Essential |
$35.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.81
|
|
|
PR PUSH TRANSFUSION BLOOD 2 YR OR YOUNGER
|
Professional
|
Both
|
$202.79
|
|
|
Service Code
|
HCPCS 36440
|
| Min. Negotiated Rate |
$37.48 |
| Max. Negotiated Rate |
$120.49 |
| Rate for Payer: Cash Price |
$55.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.16
|
| Rate for Payer: Healthfirst Commercial |
$53.55
|
| Rate for Payer: Healthfirst Essential Plan |
$120.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.87
|
| Rate for Payer: Healthfirst QHP |
$53.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.16
|
| Rate for Payer: SOMOS Essential |
$40.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.55
|
|
|
PR PVB THORACIC CONT CATHETER INFUSION W/IMG GID
|
Professional
|
Both
|
$334.81
|
|
|
Service Code
|
HCPCS 64463
|
| Min. Negotiated Rate |
$62.52 |
| Max. Negotiated Rate |
$200.97 |
| Rate for Payer: Cash Price |
$90.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.99
|
| Rate for Payer: Healthfirst Commercial |
$89.32
|
| Rate for Payer: Healthfirst Essential Plan |
$200.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.85
|
| Rate for Payer: Healthfirst QHP |
$89.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.99
|
| Rate for Payer: SOMOS Essential |
$66.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.32
|
|
|
PR PVB THORACIC SECOND & ADDL INJ SITE W/IMG GID
|
Professional
|
Both
|
$199.64
|
|
|
Service Code
|
HCPCS 64462
|
| Min. Negotiated Rate |
$36.78 |
| Max. Negotiated Rate |
$118.22 |
| Rate for Payer: Cash Price |
$53.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.41
|
| Rate for Payer: Healthfirst Commercial |
$52.54
|
| Rate for Payer: Healthfirst Essential Plan |
$118.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.91
|
| Rate for Payer: Healthfirst QHP |
$52.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.41
|
| Rate for Payer: SOMOS Essential |
$39.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.54
|
|
|
PR PVB THORACIC SINGLE INJECTION SITE W/IMG GID
|
Professional
|
Both
|
$321.76
|
|
|
Service Code
|
HCPCS 64461
|
| Min. Negotiated Rate |
$59.99 |
| Max. Negotiated Rate |
$192.82 |
| Rate for Payer: Cash Price |
$86.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.28
|
| Rate for Payer: Healthfirst Commercial |
$85.70
|
| Rate for Payer: Healthfirst Essential Plan |
$192.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.42
|
| Rate for Payer: Healthfirst QHP |
$85.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.28
|
| Rate for Payer: SOMOS Essential |
$64.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.70
|
|
|
PR PYELOPLASTY COMPLICATED
|
Professional
|
Both
|
$5,816.58
|
|
|
Service Code
|
HCPCS 50405
|
| Min. Negotiated Rate |
$1,103.94 |
| Max. Negotiated Rate |
$3,548.39 |
| Rate for Payer: Cash Price |
$1,587.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,577.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,419.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,419.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,498.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,577.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,498.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,577.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,577.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,182.80
|
| Rate for Payer: Healthfirst Commercial |
$1,577.06
|
| Rate for Payer: Healthfirst Essential Plan |
$3,548.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,498.21
|
| Rate for Payer: Healthfirst QHP |
$1,577.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,103.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,577.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,340.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,103.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,577.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,182.80
|
| Rate for Payer: SOMOS Essential |
$1,182.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,577.06
|
|
|
PR PYELOPLASTY SIMPLE
|
Professional
|
Both
|
$4,815.48
|
|
|
Service Code
|
HCPCS 50400
|
| Min. Negotiated Rate |
$915.23 |
| Max. Negotiated Rate |
$2,941.81 |
| Rate for Payer: Cash Price |
$1,316.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,307.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,176.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,176.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,242.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,307.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,242.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,307.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,307.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$980.60
|
| Rate for Payer: Healthfirst Commercial |
$1,307.47
|
| Rate for Payer: Healthfirst Essential Plan |
$2,941.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,242.10
|
| Rate for Payer: Healthfirst QHP |
$1,307.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$915.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,307.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,111.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$915.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,307.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$980.60
|
| Rate for Payer: SOMOS Essential |
$980.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,307.47
|
|
|
PR PYELOTOMY COMPLICATED
|
Professional
|
Both
|
$4,678.07
|
|
|
Service Code
|
HCPCS 50135
|
| Rate for Payer: Cash Price |
$1,276.82
|
|
|
PR PYELOTOMY W/DRAINAGE PYELOSTOMY
|
Professional
|
Both
|
$4,097.38
|
|
|
Service Code
|
HCPCS 50125
|
| Min. Negotiated Rate |
$780.17 |
| Max. Negotiated Rate |
$2,507.69 |
| Rate for Payer: Cash Price |
$1,121.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,114.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,003.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,003.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,058.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,114.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,058.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,114.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,114.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$835.90
|
| Rate for Payer: Healthfirst Commercial |
$1,114.53
|
| Rate for Payer: Healthfirst Essential Plan |
$2,507.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,058.80
|
| Rate for Payer: Healthfirst QHP |
$1,114.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$780.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,114.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$947.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$780.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,114.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$835.90
|
| Rate for Payer: SOMOS Essential |
$835.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,114.53
|
|
|
PR PYELOTOMY W/EXPLORATION
|
Professional
|
Both
|
$3,962.88
|
|
|
Service Code
|
HCPCS 50120
|
| Min. Negotiated Rate |
$754.87 |
| Max. Negotiated Rate |
$2,426.38 |
| Rate for Payer: Cash Price |
$1,084.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,078.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$970.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$970.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,024.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,078.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,024.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,078.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,078.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$808.79
|
| Rate for Payer: Healthfirst Commercial |
$1,078.39
|
| Rate for Payer: Healthfirst Essential Plan |
$2,426.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,024.47
|
| Rate for Payer: Healthfirst QHP |
$1,078.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$754.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,078.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$916.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$754.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,078.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$808.79
|
| Rate for Payer: SOMOS Essential |
$808.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,078.39
|
|
|
PR PYELOTOMY W/REMOVAL CALCULUS
|
Professional
|
Both
|
$4,312.56
|
|
|
Service Code
|
HCPCS 50130
|
| Min. Negotiated Rate |
$819.69 |
| Max. Negotiated Rate |
$2,634.70 |
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,170.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,053.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,053.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,112.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,170.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,112.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,170.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,170.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$878.24
|
| Rate for Payer: Healthfirst Commercial |
$1,170.98
|
| Rate for Payer: Healthfirst Essential Plan |
$2,634.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,112.43
|
| Rate for Payer: Healthfirst QHP |
$1,170.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$819.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,170.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$995.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$819.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,170.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$878.24
|
| Rate for Payer: SOMOS Essential |
$878.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,170.98
|
|
|
PR PYLOROMYOTOMY CUTTING PYLORIC MUSC
|
Professional
|
Both
|
$3,081.19
|
|
|
Service Code
|
HCPCS 43520
|
| Min. Negotiated Rate |
$599.73 |
| Max. Negotiated Rate |
$1,927.69 |
| Rate for Payer: Cash Price |
$828.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$856.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$771.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$771.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$813.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$856.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$813.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$856.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$856.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$642.56
|
| Rate for Payer: Healthfirst Commercial |
$856.75
|
| Rate for Payer: Healthfirst Essential Plan |
$1,927.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$813.91
|
| Rate for Payer: Healthfirst QHP |
$856.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$599.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$856.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$728.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$599.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$856.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$642.56
|
| Rate for Payer: SOMOS Essential |
$642.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$856.75
|
|
|
PR PYLOROPLASTY
|
Professional
|
Both
|
$4,196.05
|
|
|
Service Code
|
HCPCS 43800
|
| Min. Negotiated Rate |
$777.73 |
| Max. Negotiated Rate |
$2,499.84 |
| Rate for Payer: Cash Price |
$1,120.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,111.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$999.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$999.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,055.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,111.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,055.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,111.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,111.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$833.28
|
| Rate for Payer: Healthfirst Commercial |
$1,111.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,499.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,055.49
|
| Rate for Payer: Healthfirst QHP |
$1,111.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$777.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,111.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$944.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$777.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,111.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$833.28
|
| Rate for Payer: SOMOS Essential |
$833.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,111.04
|
|
|
PR QNHP OL DIGITAL ASSMT&MGMT EST PT <7 D 11-20 MIN
|
Professional
|
Both
|
$77.98
|
|
|
Service Code
|
HCPCS 98971
|
| Min. Negotiated Rate |
$17.07 |
| Max. Negotiated Rate |
$54.88 |
| Rate for Payer: Cash Price |
$22.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.29
|
| Rate for Payer: Healthfirst Commercial |
$24.39
|
| Rate for Payer: Healthfirst Essential Plan |
$54.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.17
|
| Rate for Payer: Healthfirst QHP |
$24.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.29
|
| Rate for Payer: SOMOS Essential |
$18.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.39
|
|
|
PR QNHP OL DIGITAL ASSMT&MGMT EST PT <7 D 21+ MIN
|
Professional
|
Both
|
$120.65
|
|
|
Service Code
|
HCPCS 98972
|
| Min. Negotiated Rate |
$25.27 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.07
|
| Rate for Payer: Healthfirst Commercial |
$36.10
|
| Rate for Payer: Healthfirst Essential Plan |
$81.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.30
|
| Rate for Payer: Healthfirst QHP |
$36.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.07
|
| Rate for Payer: SOMOS Essential |
$27.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.10
|
|
|
PR QNHP OL DIGITAL ASSMT&MGMT EST PT <7 D 5-10 MIN
|
Professional
|
Both
|
$45.54
|
|
|
Service Code
|
HCPCS 98970
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$28.62 |
| Rate for Payer: Cash Price |
$12.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.54
|
| Rate for Payer: Healthfirst Commercial |
$12.72
|
| Rate for Payer: Healthfirst Essential Plan |
$28.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.08
|
| Rate for Payer: Healthfirst QHP |
$12.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.54
|
| Rate for Payer: SOMOS Essential |
$9.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.72
|
|
|
PR QUADRICEPSPLASTY
|
Professional
|
Both
|
$3,292.77
|
|
|
Service Code
|
HCPCS 27430
|
| Min. Negotiated Rate |
$619.98 |
| Max. Negotiated Rate |
$1,992.78 |
| Rate for Payer: Cash Price |
$891.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$885.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$797.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$797.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$841.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$885.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$841.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$885.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$885.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$664.26
|
| Rate for Payer: Healthfirst Commercial |
$885.68
|
| Rate for Payer: Healthfirst Essential Plan |
$1,992.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$841.40
|
| Rate for Payer: Healthfirst QHP |
$885.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$619.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$885.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$752.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$619.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$885.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$664.26
|
| Rate for Payer: SOMOS Essential |
$664.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$885.68
|
|
|
PR QUANTITATIVE PUPILLOMETRY PHYS/QHP I&R UNI/BI
|
Professional
|
Both
|
$65.38
|
|
|
Service Code
|
HCPCS 95919
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$41.20 |
| Rate for Payer: Cash Price |
$18.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.73
|
| Rate for Payer: Healthfirst Commercial |
$18.31
|
| Rate for Payer: Healthfirst Essential Plan |
$41.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.39
|
| Rate for Payer: Healthfirst QHP |
$18.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.73
|
| Rate for Payer: SOMOS Essential |
$13.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.31
|
|
|
PR QUANTITATIVE PUPILLOMETRY PHYS/QHP I&R UNI/BI
|
Professional
|
Both
|
$39.66
|
|
|
Service Code
|
HCPCS 95919 26
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$24.07 |
| Rate for Payer: Cash Price |
$10.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.03
|
| Rate for Payer: Healthfirst Commercial |
$10.70
|
| Rate for Payer: Healthfirst Essential Plan |
$24.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.16
|
| Rate for Payer: Healthfirst QHP |
$10.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.03
|
| Rate for Payer: SOMOS Essential |
$8.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.70
|
|
|
PR QUANTITATIVE PUPILLOMETRY PHYS/QHP I&R UNI/BI
|
Professional
|
Both
|
$25.73
|
|
|
Service Code
|
HCPCS 95919 TC
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Cash Price |
$7.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.70
|
| Rate for Payer: Healthfirst Commercial |
$7.60
|
| Rate for Payer: Healthfirst Essential Plan |
$17.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.22
|
| Rate for Payer: Healthfirst QHP |
$7.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.70
|
| Rate for Payer: SOMOS Essential |
$5.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.60
|
|
