|
PR RX&FITG C-LENS TECH CRNL LENS APHAKIA 1 EYE
|
Professional
|
Both
|
$82.11
|
|
|
Service Code
|
HCPCS 92315
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$50.24 |
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.75
|
| Rate for Payer: Healthfirst Commercial |
$22.33
|
| Rate for Payer: Healthfirst Essential Plan |
$50.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.21
|
| Rate for Payer: Healthfirst QHP |
$22.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.75
|
| Rate for Payer: SOMOS Essential |
$16.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.33
|
|
|
PR RX&FITG C-LENS TECH CRNL LENS APHAKIA BOTH EYES
|
Professional
|
Both
|
$122.40
|
|
|
Service Code
|
HCPCS 92316
|
| Min. Negotiated Rate |
$23.35 |
| Max. Negotiated Rate |
$75.06 |
| Rate for Payer: Cash Price |
$33.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.02
|
| Rate for Payer: Healthfirst Commercial |
$33.36
|
| Rate for Payer: Healthfirst Essential Plan |
$75.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.69
|
| Rate for Payer: Healthfirst QHP |
$33.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.02
|
| Rate for Payer: SOMOS Essential |
$25.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.36
|
|
|
PR RX&FITG CONTACT LENS CORNEAL LENS APHAKIA 1 EYE
|
Professional
|
Both
|
$201.25
|
|
|
Service Code
|
HCPCS 92311
|
| Min. Negotiated Rate |
$37.62 |
| Max. Negotiated Rate |
$151.50 |
| Rate for Payer: Amida Care Medicaid |
$151.50
|
| Rate for Payer: Cash Price |
$54.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.30
|
| Rate for Payer: Healthfirst Commercial |
$53.74
|
| Rate for Payer: Healthfirst Essential Plan |
$120.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.05
|
| Rate for Payer: Healthfirst QHP |
$53.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.30
|
| Rate for Payer: SOMOS Essential |
$40.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.74
|
|
|
PR RX&FITG CONTACT LENS CORNEAL LENS APHAKIA OU
|
Professional
|
Both
|
$232.44
|
|
|
Service Code
|
HCPCS 92312
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$252.50 |
| Rate for Payer: Amida Care Medicaid |
$252.50
|
| Rate for Payer: Cash Price |
$65.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.08
|
| Rate for Payer: Healthfirst Commercial |
$65.44
|
| Rate for Payer: Healthfirst Essential Plan |
$147.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.17
|
| Rate for Payer: Healthfirst QHP |
$65.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.08
|
| Rate for Payer: SOMOS Essential |
$49.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.44
|
|
|
PR RX&FITG CONTACT LENS CORNEOSCLERAL LENS
|
Professional
|
Both
|
$166.85
|
|
|
Service Code
|
HCPCS 92313
|
| Min. Negotiated Rate |
$31.86 |
| Max. Negotiated Rate |
$126.25 |
| Rate for Payer: Amida Care Medicaid |
$126.25
|
| Rate for Payer: Cash Price |
$45.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.13
|
| Rate for Payer: Healthfirst Commercial |
$45.51
|
| Rate for Payer: Healthfirst Essential Plan |
$102.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.23
|
| Rate for Payer: Healthfirst QHP |
$45.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.13
|
| Rate for Payer: SOMOS Essential |
$34.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.51
|
|
|
PR RX&FITG CONTACT LENS TECH CORNEOSCLERAL LENS
|
Professional
|
Both
|
$82.11
|
|
|
Service Code
|
HCPCS 92317
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$50.24 |
| Rate for Payer: Cash Price |
$22.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.75
|
| Rate for Payer: Healthfirst Commercial |
$22.33
|
| Rate for Payer: Healthfirst Essential Plan |
$50.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.21
|
| Rate for Payer: Healthfirst QHP |
$22.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.75
|
| Rate for Payer: SOMOS Essential |
$16.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.33
|
|
|
PR RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE
|
Professional
|
Both
|
$426.09
|
|
|
Service Code
|
HCPCS 95954 26
|
| Min. Negotiated Rate |
$83.57 |
| Max. Negotiated Rate |
$268.61 |
| Rate for Payer: Amida Care Medicaid |
$202.19
|
| Rate for Payer: Cash Price |
$121.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.53
|
| Rate for Payer: Healthfirst Commercial |
$119.38
|
| Rate for Payer: Healthfirst Essential Plan |
$268.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.41
|
| Rate for Payer: Healthfirst QHP |
$119.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.53
|
| Rate for Payer: SOMOS Essential |
$89.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.38
|
|
|
PR RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE
|
Professional
|
Both
|
$1,285.59
|
|
|
Service Code
|
HCPCS 95954 TC
|
| Min. Negotiated Rate |
$202.19 |
| Max. Negotiated Rate |
$722.38 |
| Rate for Payer: Amida Care Medicaid |
$202.19
|
| Rate for Payer: Cash Price |
$336.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$321.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$288.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$288.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$305.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$321.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$305.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$240.79
|
| Rate for Payer: Healthfirst Commercial |
$321.06
|
| Rate for Payer: Healthfirst Essential Plan |
$722.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$305.01
|
| Rate for Payer: Healthfirst QHP |
$321.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$224.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$321.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$272.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$224.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$321.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$240.79
|
| Rate for Payer: SOMOS Essential |
$240.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$321.06
|
|
|
PR RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE
|
Professional
|
Both
|
$1,711.68
|
|
|
Service Code
|
HCPCS 95954
|
| Min. Negotiated Rate |
$202.19 |
| Max. Negotiated Rate |
$990.99 |
| Rate for Payer: Amida Care Medicaid |
$202.19
|
| Rate for Payer: Cash Price |
$457.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$440.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$396.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$396.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$418.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$440.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$418.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$440.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$440.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$330.33
|
| Rate for Payer: Healthfirst Commercial |
$440.44
|
| Rate for Payer: Healthfirst Essential Plan |
$990.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$418.42
|
| Rate for Payer: Healthfirst QHP |
$440.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$308.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$440.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$374.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$308.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$440.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$330.33
|
| Rate for Payer: SOMOS Essential |
$330.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$440.44
|
|
|
PR RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR
|
Professional
|
Both
|
$501.41
|
|
|
Service Code
|
HCPCS 92607
|
| Min. Negotiated Rate |
$80.91 |
| Max. Negotiated Rate |
$310.52 |
| Rate for Payer: Amida Care Medicaid |
$80.91
|
| Rate for Payer: Cash Price |
$139.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.51
|
| Rate for Payer: Healthfirst Commercial |
$138.01
|
| Rate for Payer: Healthfirst Essential Plan |
$310.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$131.11
|
| Rate for Payer: Healthfirst QHP |
$138.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$138.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.51
|
| Rate for Payer: SOMOS Essential |
$103.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.01
|
|
|
PR RX SP-GENRATJ AUGMNT&COMUNICAJ DEV EA 30 MIN
|
Professional
|
Both
|
$198.10
|
|
|
Service Code
|
HCPCS 92608
|
| Min. Negotiated Rate |
$15.87 |
| Max. Negotiated Rate |
$122.53 |
| Rate for Payer: Amida Care Medicaid |
$15.87
|
| Rate for Payer: Cash Price |
$54.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.84
|
| Rate for Payer: Healthfirst Commercial |
$54.46
|
| Rate for Payer: Healthfirst Essential Plan |
$122.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.74
|
| Rate for Payer: Healthfirst QHP |
$54.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.84
|
| Rate for Payer: SOMOS Essential |
$40.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.46
|
|
|
PR SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX
|
Professional
|
Both
|
$3,521.21
|
|
|
Service Code
|
HCPCS 58700
|
| Min. Negotiated Rate |
$656.87 |
| Max. Negotiated Rate |
$2,111.36 |
| Rate for Payer: Cash Price |
$948.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$938.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$844.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$844.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$891.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$938.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$891.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$938.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$938.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$703.78
|
| Rate for Payer: Healthfirst Commercial |
$938.38
|
| Rate for Payer: Healthfirst Essential Plan |
$2,111.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.46
|
| Rate for Payer: Healthfirst QHP |
$938.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$656.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$938.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$797.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$656.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$938.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$703.78
|
| Rate for Payer: SOMOS Essential |
$703.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$938.38
|
|
|
PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX
|
Professional
|
Both
|
$3,315.45
|
|
|
Service Code
|
HCPCS 58720
|
| Min. Negotiated Rate |
$620.97 |
| Max. Negotiated Rate |
$1,995.97 |
| Rate for Payer: Cash Price |
$898.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$887.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$798.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$798.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$842.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$887.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$842.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$887.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$887.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$665.33
|
| Rate for Payer: Healthfirst Commercial |
$887.10
|
| Rate for Payer: Healthfirst Essential Plan |
$1,995.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$842.75
|
| Rate for Payer: Healthfirst QHP |
$887.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$620.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$887.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$754.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$620.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$887.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$665.33
|
| Rate for Payer: SOMOS Essential |
$665.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$887.10
|
|
|
PR SALPINGOSTOMY
|
Professional
|
Both
|
$3,768.17
|
|
|
Service Code
|
HCPCS 58770
|
| Min. Negotiated Rate |
$698.46 |
| Max. Negotiated Rate |
$2,245.05 |
| Rate for Payer: Cash Price |
$1,013.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$997.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$898.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$947.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$997.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$947.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$997.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$997.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$748.35
|
| Rate for Payer: Healthfirst Commercial |
$997.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,245.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$947.91
|
| Rate for Payer: Healthfirst QHP |
$997.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$698.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$997.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$848.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$698.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$997.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$748.35
|
| Rate for Payer: SOMOS Essential |
$748.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$997.80
|
|
|
PR SAPHENOPOPLITEAL VEIN ANASTOMOSIS
|
Professional
|
Both
|
$4,189.19
|
|
|
Service Code
|
HCPCS 34530
|
| Min. Negotiated Rate |
$769.75 |
| Max. Negotiated Rate |
$2,474.21 |
| Rate for Payer: Cash Price |
$1,111.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,099.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$989.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$989.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,044.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,099.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,044.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,099.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,099.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$824.74
|
| Rate for Payer: Healthfirst Commercial |
$1,099.65
|
| Rate for Payer: Healthfirst Essential Plan |
$2,474.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,044.67
|
| Rate for Payer: Healthfirst QHP |
$1,099.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$769.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,099.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$934.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$769.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,099.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$824.74
|
| Rate for Payer: SOMOS Essential |
$824.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,099.65
|
|
|
PR SAT BIOPSY 10-20
|
Professional
|
Both
|
$682.92
|
|
|
Service Code
|
HCPCS G0416 26
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$417.87 |
| Rate for Payer: Cash Price |
$187.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.29
|
| Rate for Payer: Healthfirst Commercial |
$185.72
|
| Rate for Payer: Healthfirst Essential Plan |
$417.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.43
|
| Rate for Payer: Healthfirst QHP |
$185.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.29
|
| Rate for Payer: SOMOS Essential |
$139.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.72
|
|
|
PR SAT BIOPSY 10-20
|
Professional
|
Both
|
$804.44
|
|
|
Service Code
|
HCPCS G0416 TC
|
| Min. Negotiated Rate |
$158.24 |
| Max. Negotiated Rate |
$508.61 |
| Rate for Payer: Cash Price |
$227.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$226.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$214.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$214.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.54
|
| Rate for Payer: Healthfirst Commercial |
$226.05
|
| Rate for Payer: Healthfirst Essential Plan |
$508.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$214.75
|
| Rate for Payer: Healthfirst QHP |
$226.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$226.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$226.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.54
|
| Rate for Payer: SOMOS Essential |
$169.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.05
|
|
|
PR SAT BIOPSY 10-20
|
Professional
|
Both
|
$1,487.36
|
|
|
Service Code
|
HCPCS G0416
|
| Min. Negotiated Rate |
$288.24 |
| Max. Negotiated Rate |
$926.48 |
| Rate for Payer: Cash Price |
$414.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$411.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$370.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$370.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$391.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$411.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$391.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$411.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$308.83
|
| Rate for Payer: Healthfirst Commercial |
$411.77
|
| Rate for Payer: Healthfirst Essential Plan |
$926.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.18
|
| Rate for Payer: Healthfirst QHP |
$411.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$288.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$411.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$350.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$288.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$411.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$308.83
|
| Rate for Payer: SOMOS Essential |
$308.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$411.77
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
Both
|
$484.96
|
|
|
Service Code
|
HCPCS 99233
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$292.63 |
| Rate for Payer: Amida Care Medicaid |
$37.65
|
| Rate for Payer: Cash Price |
$131.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.55
|
| Rate for Payer: Healthfirst Commercial |
$130.06
|
| Rate for Payer: Healthfirst Essential Plan |
$292.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$123.56
|
| Rate for Payer: Healthfirst QHP |
$130.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.55
|
| Rate for Payer: SOMOS Essential |
$97.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.06
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$322.53
|
|
|
Service Code
|
HCPCS 99232
|
| Min. Negotiated Rate |
$26.27 |
| Max. Negotiated Rate |
$197.21 |
| Rate for Payer: Amida Care Medicaid |
$26.27
|
| Rate for Payer: Cash Price |
$87.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.74
|
| Rate for Payer: Healthfirst Commercial |
$87.65
|
| Rate for Payer: Healthfirst Essential Plan |
$197.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.27
|
| Rate for Payer: Healthfirst QHP |
$87.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.74
|
| Rate for Payer: SOMOS Essential |
$65.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.65
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
Both
|
$205.80
|
|
|
Service Code
|
HCPCS 99231
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$121.81 |
| Rate for Payer: Amida Care Medicaid |
$14.72
|
| Rate for Payer: Cash Price |
$55.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.60
|
| Rate for Payer: Healthfirst Commercial |
$54.14
|
| Rate for Payer: Healthfirst Essential Plan |
$121.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.43
|
| Rate for Payer: Healthfirst QHP |
$54.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.60
|
| Rate for Payer: SOMOS Essential |
$40.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.14
|
|
|
PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
Both
|
$624.05
|
|
|
Service Code
|
HCPCS 99310
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$383.71 |
| Rate for Payer: Amida Care Medicaid |
$47.10
|
| Rate for Payer: Cash Price |
$172.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$170.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.91
|
| Rate for Payer: Healthfirst Commercial |
$170.54
|
| Rate for Payer: Healthfirst Essential Plan |
$383.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.01
|
| Rate for Payer: Healthfirst QHP |
$170.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.91
|
| Rate for Payer: SOMOS Essential |
$127.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.54
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES
|
Professional
|
Both
|
$305.20
|
|
|
Service Code
|
HCPCS 99308
|
| Min. Negotiated Rate |
$24.14 |
| Max. Negotiated Rate |
$185.24 |
| Rate for Payer: Amida Care Medicaid |
$24.14
|
| Rate for Payer: Cash Price |
$83.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.75
|
| Rate for Payer: Healthfirst Commercial |
$82.33
|
| Rate for Payer: Healthfirst Essential Plan |
$185.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.21
|
| Rate for Payer: Healthfirst QHP |
$82.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.75
|
| Rate for Payer: SOMOS Essential |
$61.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.33
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
Both
|
$432.88
|
|
|
Service Code
|
HCPCS 99309
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$269.08 |
| Rate for Payer: Amida Care Medicaid |
$32.24
|
| Rate for Payer: Cash Price |
$120.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.69
|
| Rate for Payer: Healthfirst Commercial |
$119.59
|
| Rate for Payer: Healthfirst Essential Plan |
$269.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.61
|
| Rate for Payer: Healthfirst QHP |
$119.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.69
|
| Rate for Payer: SOMOS Essential |
$89.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.59
|
|
|
PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES
|
Professional
|
Both
|
$160.44
|
|
|
Service Code
|
HCPCS 99307
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$99.11 |
| Rate for Payer: Amida Care Medicaid |
$15.72
|
| Rate for Payer: Cash Price |
$45.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.04
|
| Rate for Payer: Healthfirst Commercial |
$44.05
|
| Rate for Payer: Healthfirst Essential Plan |
$99.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.85
|
| Rate for Payer: Healthfirst QHP |
$44.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.04
|
| Rate for Payer: SOMOS Essential |
$33.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.05
|
|
