|
PR SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS
|
Professional
|
Both
|
$407.47
|
|
|
Service Code
|
HCPCS 99493
|
| Min. Negotiated Rate |
$79.29 |
| Max. Negotiated Rate |
$254.86 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.95
|
| Rate for Payer: Healthfirst Commercial |
$113.27
|
| Rate for Payer: Healthfirst Essential Plan |
$254.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.61
|
| Rate for Payer: Healthfirst QHP |
$113.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.95
|
| Rate for Payer: SOMOS Essential |
$84.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.27
|
|
|
PR SCAPULOPEXY
|
Professional
|
Both
|
$4,310.25
|
|
|
Service Code
|
HCPCS 23400
|
| Min. Negotiated Rate |
$809.16 |
| Max. Negotiated Rate |
$2,600.89 |
| Rate for Payer: Cash Price |
$1,161.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,155.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,040.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,040.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,098.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,155.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,098.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,155.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,155.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$866.96
|
| Rate for Payer: Healthfirst Commercial |
$1,155.95
|
| Rate for Payer: Healthfirst Essential Plan |
$2,600.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,098.15
|
| Rate for Payer: Healthfirst QHP |
$1,155.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$809.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,155.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$982.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$809.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,155.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$866.96
|
| Rate for Payer: SOMOS Essential |
$866.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,155.95
|
|
|
PR SCLERAL REINFORCEMENT SPX W/GRAFT
|
Professional
|
Both
|
$2,844.59
|
|
|
Service Code
|
HCPCS 67255
|
| Min. Negotiated Rate |
$540.06 |
| Max. Negotiated Rate |
$1,735.92 |
| Rate for Payer: Cash Price |
$784.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$771.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$694.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$694.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$732.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$771.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$732.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$771.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$771.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$578.64
|
| Rate for Payer: Healthfirst Commercial |
$771.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,735.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$732.94
|
| Rate for Payer: Healthfirst QHP |
$771.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$540.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$771.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$655.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$540.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$771.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$578.64
|
| Rate for Payer: SOMOS Essential |
$578.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$771.52
|
|
|
PR SCLERAL REINFORCEMENT SPX W/O GRAFT
|
Professional
|
Both
|
$3,792.36
|
|
|
Service Code
|
HCPCS 67250
|
| Min. Negotiated Rate |
$705.02 |
| Max. Negotiated Rate |
$2,266.13 |
| Rate for Payer: Cash Price |
$1,035.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,007.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$906.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$906.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$956.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,007.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$956.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,007.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,007.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$755.38
|
| Rate for Payer: Healthfirst Commercial |
$1,007.17
|
| Rate for Payer: Healthfirst Essential Plan |
$2,266.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$956.81
|
| Rate for Payer: Healthfirst QHP |
$1,007.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$705.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,007.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$856.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$705.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,007.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$755.38
|
| Rate for Payer: SOMOS Essential |
$755.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,007.17
|
|
|
PR SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID
|
Professional
|
Both
|
$489.23
|
|
|
Service Code
|
HCPCS 49185
|
| Min. Negotiated Rate |
$93.51 |
| Max. Negotiated Rate |
$300.58 |
| Rate for Payer: Cash Price |
$133.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$133.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$133.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.19
|
| Rate for Payer: Healthfirst Commercial |
$133.59
|
| Rate for Payer: Healthfirst Essential Plan |
$300.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.91
|
| Rate for Payer: Healthfirst QHP |
$133.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$133.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$133.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.19
|
| Rate for Payer: SOMOS Essential |
$100.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.59
|
|
|
PR SCR C/V CYTO,AUTOSYS AND MD
|
Professional
|
Both
|
$94.26
|
|
|
Service Code
|
HCPCS G0141
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$63.47 |
| Rate for Payer: Cash Price |
$27.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.16
|
| Rate for Payer: Healthfirst Commercial |
$28.21
|
| Rate for Payer: Healthfirst Essential Plan |
$63.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.80
|
| Rate for Payer: Healthfirst QHP |
$28.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.16
|
| Rate for Payer: SOMOS Essential |
$21.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.21
|
|
|
PR SCREEN C/V THIN LAYER BY MD
|
Professional
|
Both
|
$94.26
|
|
|
Service Code
|
HCPCS G0124
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$63.47 |
| Rate for Payer: Cash Price |
$27.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.16
|
| Rate for Payer: Healthfirst Commercial |
$28.21
|
| Rate for Payer: Healthfirst Essential Plan |
$63.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.80
|
| Rate for Payer: Healthfirst QHP |
$28.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.16
|
| Rate for Payer: SOMOS Essential |
$21.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.21
|
|
|
PR SCREENING PAP SMEAR BY PHYS
|
Professional
|
Both
|
$94.26
|
|
|
Service Code
|
HCPCS P3001
|
| Min. Negotiated Rate |
$19.75 |
| Max. Negotiated Rate |
$63.47 |
| Rate for Payer: Cash Price |
$27.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.16
|
| Rate for Payer: Healthfirst Commercial |
$28.21
|
| Rate for Payer: Healthfirst Essential Plan |
$63.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.80
|
| Rate for Payer: Healthfirst QHP |
$28.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.16
|
| Rate for Payer: SOMOS Essential |
$21.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.21
|
|
|
PR SCREENING TEST PURE TONE AIR ONLY
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 92551
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Amida Care Medicaid |
$5.36
|
|
|
PR SCROTAL EXPLORATION
|
Professional
|
Both
|
$1,641.47
|
|
|
Service Code
|
HCPCS 55110
|
| Min. Negotiated Rate |
$314.74 |
| Max. Negotiated Rate |
$1,011.67 |
| Rate for Payer: Cash Price |
$450.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$449.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$404.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$404.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$427.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$449.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$427.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$449.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$449.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$337.22
|
| Rate for Payer: Healthfirst Commercial |
$449.63
|
| Rate for Payer: Healthfirst Essential Plan |
$1,011.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$427.15
|
| Rate for Payer: Healthfirst QHP |
$449.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$314.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$449.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$382.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$314.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$449.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$337.22
|
| Rate for Payer: SOMOS Essential |
$337.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$449.63
|
|
|
PR SCROTOPLASTY COMPLICATED
|
Professional
|
Both
|
$2,905.32
|
|
|
Service Code
|
HCPCS 55180
|
| Min. Negotiated Rate |
$552.00 |
| Max. Negotiated Rate |
$1,774.28 |
| Rate for Payer: Cash Price |
$793.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$788.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$709.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$709.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$749.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$788.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$749.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$788.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$788.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$591.43
|
| Rate for Payer: Healthfirst Commercial |
$788.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,774.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$749.14
|
| Rate for Payer: Healthfirst QHP |
$788.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$552.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$788.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$670.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$552.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$788.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$591.43
|
| Rate for Payer: SOMOS Essential |
$591.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$788.57
|
|
|
PR SCROTOPLASTY SIMPLE
|
Professional
|
Both
|
$1,545.88
|
|
|
Service Code
|
HCPCS 55175
|
| Min. Negotiated Rate |
$294.97 |
| Max. Negotiated Rate |
$948.13 |
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$421.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$379.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$379.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$400.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$421.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$400.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$421.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$421.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$316.04
|
| Rate for Payer: Healthfirst Commercial |
$421.39
|
| Rate for Payer: Healthfirst Essential Plan |
$948.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$400.32
|
| Rate for Payer: Healthfirst QHP |
$421.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$294.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$421.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$358.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$294.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$421.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$316.04
|
| Rate for Payer: SOMOS Essential |
$316.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$421.39
|
|
|
PR SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN
|
Professional
|
Both
|
$3,673.74
|
|
|
Service Code
|
HCPCS 49900
|
| Min. Negotiated Rate |
$689.98 |
| Max. Negotiated Rate |
$2,217.80 |
| Rate for Payer: Cash Price |
$990.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$985.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$887.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$887.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$936.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$985.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$936.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$985.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$985.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$739.27
|
| Rate for Payer: Healthfirst Commercial |
$985.69
|
| Rate for Payer: Healthfirst Essential Plan |
$2,217.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$936.41
|
| Rate for Payer: Healthfirst QHP |
$985.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$689.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$985.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$837.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$689.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$985.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$739.27
|
| Rate for Payer: SOMOS Essential |
$739.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$985.69
|
|
|
PR SECONDARY CLOSURE SURG WOUND/DEHSN XTNSV/COMP
|
Professional
|
Both
|
$3,457.51
|
|
|
Service Code
|
HCPCS 13160
|
| Min. Negotiated Rate |
$651.73 |
| Max. Negotiated Rate |
$2,094.84 |
| Rate for Payer: Cash Price |
$933.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$931.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$837.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$837.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$884.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$931.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$884.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$931.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$931.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$698.28
|
| Rate for Payer: Healthfirst Commercial |
$931.04
|
| Rate for Payer: Healthfirst Essential Plan |
$2,094.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$884.49
|
| Rate for Payer: Healthfirst QHP |
$931.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$651.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$931.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$791.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$651.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$931.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$698.28
|
| Rate for Payer: SOMOS Essential |
$698.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$931.04
|
|
|
PR SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ
|
Professional
|
Both
|
$3,689.14
|
|
|
Service Code
|
HCPCS 21275
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$2,227.50 |
| Rate for Payer: Cash Price |
$995.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$990.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$891.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$940.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$990.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$940.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$990.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$990.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$742.50
|
| Rate for Payer: Healthfirst Commercial |
$990.00
|
| Rate for Payer: Healthfirst Essential Plan |
$2,227.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$940.50
|
| Rate for Payer: Healthfirst QHP |
$990.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$693.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$990.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$841.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$693.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$990.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$742.50
|
| Rate for Payer: SOMOS Essential |
$742.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$990.00
|
|
|
PR SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT
|
Professional
|
Both
|
$6,036.70
|
|
|
Service Code
|
HCPCS 61618
|
| Min. Negotiated Rate |
$1,115.71 |
| Max. Negotiated Rate |
$3,586.21 |
| Rate for Payer: Cash Price |
$1,596.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,593.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,434.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,434.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,514.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,593.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,514.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,593.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,593.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,195.40
|
| Rate for Payer: Healthfirst Commercial |
$1,593.87
|
| Rate for Payer: Healthfirst Essential Plan |
$3,586.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,514.18
|
| Rate for Payer: Healthfirst QHP |
$1,593.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,115.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,593.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,354.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,115.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,593.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,195.40
|
| Rate for Payer: SOMOS Essential |
$1,195.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,593.87
|
|
|
PR SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL
|
Professional
|
Both
|
$1,049.97
|
|
|
Service Code
|
HCPCS 37186
|
| Min. Negotiated Rate |
$195.92 |
| Max. Negotiated Rate |
$629.75 |
| Rate for Payer: Cash Price |
$280.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$279.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$251.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$265.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$279.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$265.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$279.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$279.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$209.92
|
| Rate for Payer: Healthfirst Commercial |
$279.89
|
| Rate for Payer: Healthfirst Essential Plan |
$629.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$265.90
|
| Rate for Payer: Healthfirst QHP |
$279.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$195.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$279.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$237.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$195.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$279.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$209.92
|
| Rate for Payer: SOMOS Essential |
$209.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$279.89
|
|
|
PR SEC RPR DURA CSF LEAK LOCAL/REGIONALIZED FLAP
|
Professional
|
Both
|
$6,547.80
|
|
|
Service Code
|
HCPCS 61619
|
| Min. Negotiated Rate |
$1,204.15 |
| Max. Negotiated Rate |
$3,870.47 |
| Rate for Payer: Cash Price |
$1,749.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,720.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,548.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,548.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,634.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,720.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,634.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,720.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,720.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,290.16
|
| Rate for Payer: Healthfirst Commercial |
$1,720.21
|
| Rate for Payer: Healthfirst Essential Plan |
$3,870.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,634.20
|
| Rate for Payer: Healthfirst QHP |
$1,720.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,204.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,720.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,462.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,204.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,720.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,290.16
|
| Rate for Payer: SOMOS Essential |
$1,290.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,720.21
|
|
|
PR SELECT PICTURE AUDIOMETRY
|
Professional
|
Both
|
$234.19
|
|
|
Service Code
|
HCPCS 92583
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$155.97 |
| Rate for Payer: Cash Price |
$67.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.99
|
| Rate for Payer: Healthfirst Commercial |
$69.32
|
| Rate for Payer: Healthfirst Essential Plan |
$155.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.85
|
| Rate for Payer: Healthfirst QHP |
$69.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.99
|
| Rate for Payer: SOMOS Essential |
$51.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.32
|
|
|
PR SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES
|
Professional
|
Both
|
$133.84
|
|
|
Service Code
|
HCPCS 97535
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$82.55 |
| Rate for Payer: Cash Price |
$36.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.52
|
| Rate for Payer: Healthfirst Commercial |
$36.69
|
| Rate for Payer: Healthfirst Essential Plan |
$82.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.86
|
| Rate for Payer: Healthfirst QHP |
$36.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.52
|
| Rate for Payer: SOMOS Essential |
$27.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.69
|
|
|
PR SELF-MEAS BP 2 READG 1 MIN APART BID 30 DAY PD
|
Professional
|
Both
|
$35.35
|
|
|
Service Code
|
HCPCS 99474
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$21.46 |
| Rate for Payer: Cash Price |
$9.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.16
|
| Rate for Payer: Healthfirst Commercial |
$9.54
|
| Rate for Payer: Healthfirst Essential Plan |
$21.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.06
|
| Rate for Payer: Healthfirst QHP |
$9.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.16
|
| Rate for Payer: SOMOS Essential |
$7.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.54
|
|
|
PR SELF-MEAS BP PT EDUCAJ/TRAING & DEV CALIBRATION
|
Professional
|
Both
|
$55.93
|
|
|
Service Code
|
HCPCS 99473
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.69
|
| Rate for Payer: Healthfirst Commercial |
$16.92
|
| Rate for Payer: Healthfirst Essential Plan |
$38.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.07
|
| Rate for Payer: Healthfirst QHP |
$16.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.69
|
| Rate for Payer: SOMOS Essential |
$12.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.92
|
|
|
PR SENSORINEURAL ACUITY LEVEL
|
Professional
|
Both
|
$323.16
|
|
|
Service Code
|
HCPCS 92575
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$194.92 |
| Rate for Payer: Cash Price |
$87.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.97
|
| Rate for Payer: Healthfirst Commercial |
$86.63
|
| Rate for Payer: Healthfirst Essential Plan |
$194.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.30
|
| Rate for Payer: Healthfirst QHP |
$86.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.97
|
| Rate for Payer: SOMOS Essential |
$64.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.63
|
|
|
PR SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX
|
Professional
|
Both
|
$143.78
|
|
|
Service Code
|
HCPCS 92060 26
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$88.94 |
| Rate for Payer: Amida Care Medicaid |
$42.01
|
| Rate for Payer: Cash Price |
$40.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.65
|
| Rate for Payer: Healthfirst Commercial |
$39.53
|
| Rate for Payer: Healthfirst Essential Plan |
$88.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.55
|
| Rate for Payer: Healthfirst QHP |
$39.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.65
|
| Rate for Payer: SOMOS Essential |
$29.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.53
|
|
|
PR SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX
|
Professional
|
Both
|
$116.31
|
|
|
Service Code
|
HCPCS 92060 TC
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$72.14 |
| Rate for Payer: Amida Care Medicaid |
$42.01
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.05
|
| Rate for Payer: Healthfirst Commercial |
$32.06
|
| Rate for Payer: Healthfirst Essential Plan |
$72.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.46
|
| Rate for Payer: Healthfirst QHP |
$32.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.05
|
| Rate for Payer: SOMOS Essential |
$24.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.06
|
|
