|
PR SIMPLE CYSTOMETROGRAM
|
Professional
|
Both
|
$316.16
|
|
|
Service Code
|
HCPCS 51725 26
|
| Min. Negotiated Rate |
$58.82 |
| Max. Negotiated Rate |
$189.07 |
| Rate for Payer: Cash Price |
$85.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.02
|
| Rate for Payer: Healthfirst Commercial |
$84.03
|
| Rate for Payer: Healthfirst Essential Plan |
$189.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.83
|
| Rate for Payer: Healthfirst QHP |
$84.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.02
|
| Rate for Payer: SOMOS Essential |
$63.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.03
|
|
|
PR SIMPLE CYSTOMETROGRAM
|
Professional
|
Both
|
$666.72
|
|
|
Service Code
|
HCPCS 51725 TC
|
| Min. Negotiated Rate |
$108.19 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Cash Price |
$180.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.92
|
| Rate for Payer: Healthfirst Commercial |
$154.56
|
| Rate for Payer: Healthfirst Essential Plan |
$347.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.83
|
| Rate for Payer: Healthfirst QHP |
$154.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.92
|
| Rate for Payer: SOMOS Essential |
$115.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.56
|
|
|
PR SIMPLE CYSTOMETROGRAM
|
Professional
|
Both
|
$982.87
|
|
|
Service Code
|
HCPCS 51725
|
| Min. Negotiated Rate |
$167.01 |
| Max. Negotiated Rate |
$536.83 |
| Rate for Payer: Cash Price |
$265.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$238.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$214.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$214.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$226.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$238.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$226.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$238.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$238.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$178.94
|
| Rate for Payer: Healthfirst Commercial |
$238.59
|
| Rate for Payer: Healthfirst Essential Plan |
$536.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$226.66
|
| Rate for Payer: Healthfirst QHP |
$238.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$167.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$238.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$202.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$167.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$238.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$178.94
|
| Rate for Payer: SOMOS Essential |
$178.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$238.59
|
|
|
PR SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$16,294.32
|
|
|
Service Code
|
HCPCS 61700
|
| Min. Negotiated Rate |
$2,994.71 |
| Max. Negotiated Rate |
$9,625.86 |
| Rate for Payer: Cash Price |
$4,326.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,278.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,850.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,850.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,064.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,278.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,064.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,278.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,278.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,208.62
|
| Rate for Payer: Healthfirst Commercial |
$4,278.16
|
| Rate for Payer: Healthfirst Essential Plan |
$9,625.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,064.25
|
| Rate for Payer: Healthfirst QHP |
$4,278.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,994.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,278.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,636.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,994.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,278.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,208.62
|
| Rate for Payer: SOMOS Essential |
$3,208.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,278.16
|
|
|
PR SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ
|
Professional
|
Both
|
$19,419.75
|
|
|
Service Code
|
HCPCS 61702
|
| Min. Negotiated Rate |
$3,534.26 |
| Max. Negotiated Rate |
$11,360.11 |
| Rate for Payer: Cash Price |
$5,098.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,048.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,544.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,544.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,796.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,048.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,796.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,048.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,048.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,786.70
|
| Rate for Payer: Healthfirst Commercial |
$5,048.94
|
| Rate for Payer: Healthfirst Essential Plan |
$11,360.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,796.49
|
| Rate for Payer: Healthfirst QHP |
$5,048.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,534.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,048.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,291.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,534.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,048.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,786.70
|
| Rate for Payer: SOMOS Essential |
$3,786.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,048.94
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM
|
Professional
|
Both
|
$562.91
|
|
|
Service Code
|
HCPCS 12016
|
| Min. Negotiated Rate |
$104.18 |
| Max. Negotiated Rate |
$334.87 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$148.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$133.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$148.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.62
|
| Rate for Payer: Healthfirst Commercial |
$148.83
|
| Rate for Payer: Healthfirst Essential Plan |
$334.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.39
|
| Rate for Payer: Healthfirst QHP |
$148.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$148.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$126.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$148.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.62
|
| Rate for Payer: SOMOS Essential |
$111.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.83
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM
|
Professional
|
Both
|
$683.83
|
|
|
Service Code
|
HCPCS 12017
|
| Min. Negotiated Rate |
$126.06 |
| Max. Negotiated Rate |
$405.18 |
| Rate for Payer: Cash Price |
$182.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.06
|
| Rate for Payer: Healthfirst Commercial |
$180.08
|
| Rate for Payer: Healthfirst Essential Plan |
$405.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$171.08
|
| Rate for Payer: Healthfirst QHP |
$180.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$180.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.06
|
| Rate for Payer: SOMOS Essential |
$135.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.08
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<
|
Professional
|
Both
|
$241.92
|
|
|
Service Code
|
HCPCS 12011
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$146.21 |
| Rate for Payer: Cash Price |
$65.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.73
|
| Rate for Payer: Healthfirst Commercial |
$64.98
|
| Rate for Payer: Healthfirst Essential Plan |
$146.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.73
|
| Rate for Payer: Healthfirst QHP |
$64.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.73
|
| Rate for Payer: SOMOS Essential |
$48.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.98
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM
|
Professional
|
Both
|
$260.02
|
|
|
Service Code
|
HCPCS 12013
|
| Min. Negotiated Rate |
$47.14 |
| Max. Negotiated Rate |
$151.51 |
| Rate for Payer: Cash Price |
$68.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.51
|
| Rate for Payer: Healthfirst Commercial |
$67.34
|
| Rate for Payer: Healthfirst Essential Plan |
$151.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.97
|
| Rate for Payer: Healthfirst QHP |
$67.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.51
|
| Rate for Payer: SOMOS Essential |
$50.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.34
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M >30.0 CM
|
Professional
|
Both
|
$772.35
|
|
|
Service Code
|
HCPCS 12018
|
| Min. Negotiated Rate |
$142.92 |
| Max. Negotiated Rate |
$459.38 |
| Rate for Payer: Cash Price |
$205.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$204.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$193.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$193.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.13
|
| Rate for Payer: Healthfirst Commercial |
$204.17
|
| Rate for Payer: Healthfirst Essential Plan |
$459.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$193.96
|
| Rate for Payer: Healthfirst QHP |
$204.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$204.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$204.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.13
|
| Rate for Payer: SOMOS Essential |
$153.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.17
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM
|
Professional
|
Both
|
$329.04
|
|
|
Service Code
|
HCPCS 12014
|
| Min. Negotiated Rate |
$60.35 |
| Max. Negotiated Rate |
$193.97 |
| Rate for Payer: Cash Price |
$88.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.66
|
| Rate for Payer: Healthfirst Commercial |
$86.21
|
| Rate for Payer: Healthfirst Essential Plan |
$193.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.90
|
| Rate for Payer: Healthfirst QHP |
$86.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.66
|
| Rate for Payer: SOMOS Essential |
$64.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.21
|
|
|
PR SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM
|
Professional
|
Both
|
$415.21
|
|
|
Service Code
|
HCPCS 12015
|
| Min. Negotiated Rate |
$76.74 |
| Max. Negotiated Rate |
$246.67 |
| Rate for Payer: Cash Price |
$110.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$109.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$98.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$109.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$109.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.22
|
| Rate for Payer: Healthfirst Commercial |
$109.63
|
| Rate for Payer: Healthfirst Essential Plan |
$246.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.15
|
| Rate for Payer: Healthfirst QHP |
$109.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$76.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$109.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$76.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$109.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.22
|
| Rate for Payer: SOMOS Essential |
$82.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.63
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<
|
Professional
|
Both
|
$199.15
|
|
|
Service Code
|
HCPCS 12001
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$117.05 |
| Rate for Payer: Cash Price |
$52.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.02
|
| Rate for Payer: Healthfirst Commercial |
$52.02
|
| Rate for Payer: Healthfirst Essential Plan |
$117.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.42
|
| Rate for Payer: Healthfirst QHP |
$52.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.02
|
| Rate for Payer: SOMOS Essential |
$39.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.02
|
|
|
PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM
|
Professional
|
Both
|
$637.21
|
|
|
Service Code
|
HCPCS 12007
|
| Min. Negotiated Rate |
$118.29 |
| Max. Negotiated Rate |
$380.20 |
| Rate for Payer: Cash Price |
$169.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$168.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$152.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$168.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.73
|
| Rate for Payer: Healthfirst Commercial |
$168.98
|
| Rate for Payer: Healthfirst Essential Plan |
$380.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$160.53
|
| Rate for Payer: Healthfirst QHP |
$168.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$118.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$168.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$143.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$118.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$168.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.73
|
| Rate for Payer: SOMOS Essential |
$126.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$168.98
|
|
|
PR SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM
|
Professional
|
Both
|
$320.36
|
|
|
Service Code
|
HCPCS 12004
|
| Min. Negotiated Rate |
$59.61 |
| Max. Negotiated Rate |
$191.61 |
| Rate for Payer: Cash Price |
$86.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.87
|
| Rate for Payer: Healthfirst Commercial |
$85.16
|
| Rate for Payer: Healthfirst Essential Plan |
$191.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.90
|
| Rate for Payer: Healthfirst QHP |
$85.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.87
|
| Rate for Payer: SOMOS Essential |
$63.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.16
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$24.29
|
|
|
Service Code
|
HCPCS 51736 TC
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$15.37 |
| Rate for Payer: Cash Price |
$6.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.12
|
| Rate for Payer: Healthfirst Commercial |
$6.83
|
| Rate for Payer: Healthfirst Essential Plan |
$15.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.49
|
| Rate for Payer: Healthfirst QHP |
$6.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.12
|
| Rate for Payer: SOMOS Essential |
$5.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.83
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$56.95
|
|
|
Service Code
|
HCPCS 51736
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.72
|
| Rate for Payer: Healthfirst Commercial |
$15.63
|
| Rate for Payer: Healthfirst Essential Plan |
$35.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.85
|
| Rate for Payer: Healthfirst QHP |
$15.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.72
|
| Rate for Payer: SOMOS Essential |
$11.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.63
|
|
|
PR SIMPLE UROFLOMETRY
|
Professional
|
Both
|
$32.66
|
|
|
Service Code
|
HCPCS 51736 26
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.60
|
| Rate for Payer: Healthfirst Commercial |
$8.80
|
| Rate for Payer: Healthfirst Essential Plan |
$19.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.36
|
| Rate for Payer: Healthfirst QHP |
$8.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.60
|
| Rate for Payer: SOMOS Essential |
$6.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.80
|
|
|
PR SINGLE ENERGY X-RAY STUDY
|
Professional
|
Both
|
$43.23
|
|
|
Service Code
|
HCPCS G0130 26
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$27.18 |
| Rate for Payer: Cash Price |
$11.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.06
|
| Rate for Payer: Healthfirst Commercial |
$12.08
|
| Rate for Payer: Healthfirst Essential Plan |
$27.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.48
|
| Rate for Payer: Healthfirst QHP |
$12.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.06
|
| Rate for Payer: SOMOS Essential |
$9.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.08
|
|
|
PR SINGLE ENERGY X-RAY STUDY
|
Professional
|
Both
|
$109.10
|
|
|
Service Code
|
HCPCS G0130 TC
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$71.26 |
| Rate for Payer: Cash Price |
$30.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.75
|
| Rate for Payer: Healthfirst Commercial |
$31.67
|
| Rate for Payer: Healthfirst Essential Plan |
$71.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.09
|
| Rate for Payer: Healthfirst QHP |
$31.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.75
|
| Rate for Payer: SOMOS Essential |
$23.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.67
|
|
|
PR SINGLE ENERGY X-RAY STUDY
|
Professional
|
Both
|
$152.36
|
|
|
Service Code
|
HCPCS G0130
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.81
|
| Rate for Payer: Healthfirst Commercial |
$43.75
|
| Rate for Payer: Healthfirst Essential Plan |
$98.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.56
|
| Rate for Payer: Healthfirst QHP |
$43.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.81
|
| Rate for Payer: SOMOS Essential |
$32.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.75
|
|
|
PR SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING
|
Professional
|
Both
|
$484.16
|
|
|
Service Code
|
HCPCS 92546 TC
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$308.45 |
| Rate for Payer: Amida Care Medicaid |
$67.50
|
| Rate for Payer: Cash Price |
$139.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.82
|
| Rate for Payer: Healthfirst Commercial |
$137.09
|
| Rate for Payer: Healthfirst Essential Plan |
$308.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.24
|
| Rate for Payer: Healthfirst QHP |
$137.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.82
|
| Rate for Payer: SOMOS Essential |
$102.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.09
|
|
|
PR SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING
|
Professional
|
Both
|
$59.19
|
|
|
Service Code
|
HCPCS 92546 26
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Amida Care Medicaid |
$67.50
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.03
|
| Rate for Payer: Healthfirst Commercial |
$16.04
|
| Rate for Payer: Healthfirst Essential Plan |
$36.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.24
|
| Rate for Payer: Healthfirst QHP |
$16.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.03
|
| Rate for Payer: SOMOS Essential |
$12.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.04
|
|
|
PR SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING
|
Professional
|
Both
|
$543.34
|
|
|
Service Code
|
HCPCS 92546
|
| Min. Negotiated Rate |
$67.50 |
| Max. Negotiated Rate |
$344.54 |
| Rate for Payer: Amida Care Medicaid |
$67.50
|
| Rate for Payer: Cash Price |
$155.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$153.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$137.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$137.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$145.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$153.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$145.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$153.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$153.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.85
|
| Rate for Payer: Healthfirst Commercial |
$153.13
|
| Rate for Payer: Healthfirst Essential Plan |
$344.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$145.47
|
| Rate for Payer: Healthfirst QHP |
$153.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$153.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$130.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$153.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$114.85
|
| Rate for Payer: SOMOS Essential |
$114.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$153.13
|
|
|
PR SINUSOT FRNT NONOBLIT W/OSTPL FLAP BROW INC
|
Professional
|
Both
|
$5,122.50
|
|
|
Service Code
|
HCPCS 31086
|
| Min. Negotiated Rate |
$948.89 |
| Max. Negotiated Rate |
$3,050.01 |
| Rate for Payer: Cash Price |
$1,380.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,355.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,220.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,220.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,287.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,355.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,287.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,355.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,355.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,016.67
|
| Rate for Payer: Healthfirst Commercial |
$1,355.56
|
| Rate for Payer: Healthfirst Essential Plan |
$3,050.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,287.78
|
| Rate for Payer: Healthfirst QHP |
$1,355.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$948.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,355.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,152.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$948.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,355.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,016.67
|
| Rate for Payer: SOMOS Essential |
$1,016.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,355.56
|
|
