|
PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH INSJ 1+
|
Professional
|
Both
|
$2,799.86
|
|
|
Service Code
|
HCPCS 66991
|
| Min. Negotiated Rate |
$534.79 |
| Max. Negotiated Rate |
$1,718.95 |
| Rate for Payer: Cash Price |
$772.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$763.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$687.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$687.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$725.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$763.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$725.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$763.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$763.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$572.99
|
| Rate for Payer: Healthfirst Commercial |
$763.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,718.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$725.78
|
| Rate for Payer: Healthfirst QHP |
$763.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$534.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$763.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$649.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$534.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$763.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$572.99
|
| Rate for Payer: SOMOS Essential |
$572.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$763.98
|
|
|
PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP
|
Professional
|
Both
|
$2,233.98
|
|
|
Service Code
|
HCPCS 66984
|
| Min. Negotiated Rate |
$424.65 |
| Max. Negotiated Rate |
$1,364.96 |
| Rate for Payer: Cash Price |
$614.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$606.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$545.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$545.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$576.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$606.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$576.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$606.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$606.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$454.99
|
| Rate for Payer: Healthfirst Commercial |
$606.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,364.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$576.32
|
| Rate for Payer: Healthfirst QHP |
$606.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$424.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$606.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$515.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$424.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$606.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$454.99
|
| Rate for Payer: SOMOS Essential |
$454.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$606.65
|
|
|
PR XCAPSL CTRC RMVL INSJ IO LENS PRSTH CPLX INSJ 1+
|
Professional
|
Both
|
$3,501.86
|
|
|
Service Code
|
HCPCS 66989
|
| Min. Negotiated Rate |
$666.52 |
| Max. Negotiated Rate |
$2,142.38 |
| Rate for Payer: Cash Price |
$965.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$952.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$856.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$856.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$904.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$952.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$904.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$952.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$952.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$714.13
|
| Rate for Payer: Healthfirst Commercial |
$952.17
|
| Rate for Payer: Healthfirst Essential Plan |
$2,142.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$904.56
|
| Rate for Payer: Healthfirst QHP |
$952.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$666.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$952.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$809.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$666.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$952.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$714.13
|
| Rate for Payer: SOMOS Essential |
$714.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$952.17
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG
|
Professional
|
Both
|
$122.05
|
|
|
Service Code
|
HCPCS 94617 26
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Amida Care Medicaid |
$62.47
|
| Rate for Payer: Cash Price |
$33.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.95
|
| Rate for Payer: Healthfirst Commercial |
$33.27
|
| Rate for Payer: Healthfirst Essential Plan |
$74.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.61
|
| Rate for Payer: Healthfirst QHP |
$33.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.95
|
| Rate for Payer: SOMOS Essential |
$24.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.27
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG
|
Professional
|
Both
|
$242.66
|
|
|
Service Code
|
HCPCS 94617 TC
|
| Min. Negotiated Rate |
$48.03 |
| Max. Negotiated Rate |
$154.40 |
| Rate for Payer: Amida Care Medicaid |
$62.47
|
| Rate for Payer: Cash Price |
$69.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.47
|
| Rate for Payer: Healthfirst Commercial |
$68.62
|
| Rate for Payer: Healthfirst Essential Plan |
$154.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.19
|
| Rate for Payer: Healthfirst QHP |
$68.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.47
|
| Rate for Payer: SOMOS Essential |
$51.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.62
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG
|
Professional
|
Both
|
$364.70
|
|
|
Service Code
|
HCPCS 94617
|
| Min. Negotiated Rate |
$62.47 |
| Max. Negotiated Rate |
$229.25 |
| Rate for Payer: Amida Care Medicaid |
$62.47
|
| Rate for Payer: Cash Price |
$102.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$101.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.42
|
| Rate for Payer: Healthfirst Commercial |
$101.89
|
| Rate for Payer: Healthfirst Essential Plan |
$229.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.80
|
| Rate for Payer: Healthfirst QHP |
$101.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.42
|
| Rate for Payer: SOMOS Essential |
$76.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.89
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG
|
Professional
|
Both
|
$235.48
|
|
|
Service Code
|
HCPCS 94619 TC
|
| Min. Negotiated Rate |
$36.46 |
| Max. Negotiated Rate |
$117.18 |
| Rate for Payer: Amida Care Medicaid |
$46.55
|
| Rate for Payer: Cash Price |
$52.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.06
|
| Rate for Payer: Healthfirst Commercial |
$52.08
|
| Rate for Payer: Healthfirst Essential Plan |
$117.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.48
|
| Rate for Payer: Healthfirst QHP |
$52.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.06
|
| Rate for Payer: SOMOS Essential |
$39.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.08
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG
|
Professional
|
Both
|
$88.41
|
|
|
Service Code
|
HCPCS 94619 26
|
| Min. Negotiated Rate |
$15.78 |
| Max. Negotiated Rate |
$50.72 |
| Rate for Payer: Amida Care Medicaid |
$46.55
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.91
|
| Rate for Payer: Healthfirst Commercial |
$22.54
|
| Rate for Payer: Healthfirst Essential Plan |
$50.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.41
|
| Rate for Payer: Healthfirst QHP |
$22.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.91
|
| Rate for Payer: SOMOS Essential |
$16.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.54
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG
|
Professional
|
Both
|
$323.89
|
|
|
Service Code
|
HCPCS 94619
|
| Min. Negotiated Rate |
$46.55 |
| Max. Negotiated Rate |
$167.92 |
| Rate for Payer: Amida Care Medicaid |
$46.55
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.97
|
| Rate for Payer: Healthfirst Commercial |
$74.63
|
| Rate for Payer: Healthfirst Essential Plan |
$167.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.90
|
| Rate for Payer: Healthfirst QHP |
$74.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.97
|
| Rate for Payer: SOMOS Essential |
$55.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.63
|
|
|
PR XTN CRANIECT MULTIPLE SUTURE CRANIOSYNOSTOSIS
|
Professional
|
Both
|
$9,086.60
|
|
|
Service Code
|
HCPCS 61558
|
| Min. Negotiated Rate |
$1,661.54 |
| Max. Negotiated Rate |
$5,340.67 |
| Rate for Payer: Cash Price |
$2,397.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,373.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,136.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,136.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,254.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,373.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,254.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,373.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,373.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,780.22
|
| Rate for Payer: Healthfirst Commercial |
$2,373.63
|
| Rate for Payer: Healthfirst Essential Plan |
$5,340.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,254.95
|
| Rate for Payer: Healthfirst QHP |
$2,373.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,661.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,373.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,017.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,661.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,373.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,780.22
|
| Rate for Payer: SOMOS Essential |
$1,780.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,373.63
|
|
|
PR XTN CRNEC MLT SUTR CRANIOSYNOSTOSIS W/BONE GRAFT
|
Professional
|
Both
|
$11,572.12
|
|
|
Service Code
|
HCPCS 61559
|
| Min. Negotiated Rate |
$2,116.56 |
| Max. Negotiated Rate |
$6,803.23 |
| Rate for Payer: Cash Price |
$3,050.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,023.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,721.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,721.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,872.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,023.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,872.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,023.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,023.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,267.74
|
| Rate for Payer: Healthfirst Commercial |
$3,023.66
|
| Rate for Payer: Healthfirst Essential Plan |
$6,803.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,872.48
|
| Rate for Payer: Healthfirst QHP |
$3,023.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,116.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,023.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,570.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,116.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,023.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,267.74
|
| Rate for Payer: SOMOS Essential |
$2,267.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,023.66
|
|
|
PR XTRNL CANNULA DECLTNG SPX W/BALO CATH
|
Professional
|
Both
|
$628.60
|
|
|
Service Code
|
HCPCS 36861
|
| Min. Negotiated Rate |
$113.84 |
| Max. Negotiated Rate |
$365.92 |
| Rate for Payer: Cash Price |
$164.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$162.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$146.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$146.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$154.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$162.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$154.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.97
|
| Rate for Payer: Healthfirst Commercial |
$162.63
|
| Rate for Payer: Healthfirst Essential Plan |
$365.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.50
|
| Rate for Payer: Healthfirst QHP |
$162.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$113.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$162.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$138.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$113.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$162.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.97
|
| Rate for Payer: SOMOS Essential |
$121.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$162.63
|
|
|
PR XTRNL CANNULA DECLTNG SPX W/O BALO CATH
|
Professional
|
Both
|
$499.10
|
|
|
Service Code
|
HCPCS 36860
|
| Min. Negotiated Rate |
$91.19 |
| Max. Negotiated Rate |
$293.11 |
| Rate for Payer: Cash Price |
$131.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.70
|
| Rate for Payer: Healthfirst Commercial |
$130.27
|
| Rate for Payer: Healthfirst Essential Plan |
$293.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$123.76
|
| Rate for Payer: Healthfirst QHP |
$130.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.70
|
| Rate for Payer: SOMOS Essential |
$97.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.27
|
|
|
PR XTRNL ECG & 48 HR RECORDING
|
Professional
|
Both
|
$80.36
|
|
|
Service Code
|
HCPCS 93225
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$47.68 |
| Rate for Payer: Cash Price |
$21.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.89
|
| Rate for Payer: Healthfirst Commercial |
$21.19
|
| Rate for Payer: Healthfirst Essential Plan |
$47.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.13
|
| Rate for Payer: Healthfirst QHP |
$21.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.89
|
| Rate for Payer: SOMOS Essential |
$15.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.19
|
|
|
PR XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 93224 26
|
| Min. Negotiated Rate |
$75.03 |
| Max. Negotiated Rate |
$75.03 |
| Rate for Payer: Amida Care Medicaid |
$75.03
|
|
|
PR XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I
|
Professional
|
Both
|
$308.63
|
|
|
Service Code
|
HCPCS 93224
|
| Min. Negotiated Rate |
$56.62 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: Amida Care Medicaid |
$75.03
|
| Rate for Payer: Cash Price |
$83.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.67
|
| Rate for Payer: Healthfirst Commercial |
$80.89
|
| Rate for Payer: Healthfirst Essential Plan |
$182.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.85
|
| Rate for Payer: Healthfirst QHP |
$80.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.67
|
| Rate for Payer: SOMOS Essential |
$60.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.89
|
|
|
PR XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 93227 26
|
| Min. Negotiated Rate |
$42.42 |
| Max. Negotiated Rate |
$42.42 |
| Rate for Payer: Amida Care Medicaid |
$42.42
|
|
|
PR XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS
|
Professional
|
Both
|
$71.72
|
|
|
Service Code
|
HCPCS 93227
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$43.85 |
| Rate for Payer: Amida Care Medicaid |
$42.42
|
| Rate for Payer: Cash Price |
$19.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.62
|
| Rate for Payer: Healthfirst Commercial |
$19.49
|
| Rate for Payer: Healthfirst Essential Plan |
$43.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.52
|
| Rate for Payer: Healthfirst QHP |
$19.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.62
|
| Rate for Payer: SOMOS Essential |
$14.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.49
|
|
|
PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS
|
Professional
|
Both
|
$104.13
|
|
|
Service Code
|
HCPCS 93228
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$62.35 |
| Rate for Payer: Amida Care Medicaid |
$19.89
|
| Rate for Payer: Cash Price |
$27.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.78
|
| Rate for Payer: Healthfirst Commercial |
$27.71
|
| Rate for Payer: Healthfirst Essential Plan |
$62.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.32
|
| Rate for Payer: Healthfirst QHP |
$27.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.78
|
| Rate for Payer: SOMOS Essential |
$20.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.71
|
|
|
PR XTRNL MOBILE CV TELEMETRY W/TECHNICAL SUPPORT
|
Professional
|
Both
|
$3,616.80
|
|
|
Service Code
|
HCPCS 93229
|
| Min. Negotiated Rate |
$626.77 |
| Max. Negotiated Rate |
$2,014.61 |
| Rate for Payer: Cash Price |
$961.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$895.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$805.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$805.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$850.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$895.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$850.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$895.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$895.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$671.53
|
| Rate for Payer: Healthfirst Commercial |
$895.38
|
| Rate for Payer: Healthfirst Essential Plan |
$2,014.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$850.61
|
| Rate for Payer: Healthfirst QHP |
$895.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$626.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$895.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$761.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$626.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$895.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$671.53
|
| Rate for Payer: SOMOS Essential |
$671.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$895.38
|
|
|
PR XTRNL OCULAR PHOTOG W/I&R DOCMT MED PROGRESS
|
Professional
|
Both
|
$13.30
|
|
|
Service Code
|
HCPCS 92285 26
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.63
|
| Rate for Payer: Healthfirst Commercial |
$3.51
|
| Rate for Payer: Healthfirst Essential Plan |
$7.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.33
|
| Rate for Payer: Healthfirst QHP |
$3.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.63
|
| Rate for Payer: SOMOS Essential |
$2.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.51
|
|
|
PR XTRNL OCULAR PHOTOG W/I&R DOCMT MED PROGRESS
|
Professional
|
Both
|
$100.87
|
|
|
Service Code
|
HCPCS 92285
|
| Min. Negotiated Rate |
$18.91 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.27
|
| Rate for Payer: Healthfirst Commercial |
$27.02
|
| Rate for Payer: Healthfirst Essential Plan |
$60.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.67
|
| Rate for Payer: Healthfirst QHP |
$27.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.27
|
| Rate for Payer: SOMOS Essential |
$20.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.02
|
|
|
PR XTRNL OCULAR PHOTOG W/I&R DOCMT MED PROGRESS
|
Professional
|
Both
|
$87.54
|
|
|
Service Code
|
HCPCS 92285 TC
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$52.92 |
| Rate for Payer: Cash Price |
$24.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.64
|
| Rate for Payer: Healthfirst Commercial |
$23.52
|
| Rate for Payer: Healthfirst Essential Plan |
$52.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.34
|
| Rate for Payer: Healthfirst QHP |
$23.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.64
|
| Rate for Payer: SOMOS Essential |
$17.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.52
|
|
|
PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
|
Professional
|
Both
|
$629.48
|
|
|
Service Code
|
HCPCS 93271
|
| Min. Negotiated Rate |
$111.56 |
| Max. Negotiated Rate |
$358.58 |
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$159.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$143.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$143.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$151.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$159.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$151.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$159.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$159.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$119.53
|
| Rate for Payer: Healthfirst Commercial |
$159.37
|
| Rate for Payer: Healthfirst Essential Plan |
$358.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$151.40
|
| Rate for Payer: Healthfirst QHP |
$159.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$111.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$159.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$135.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$111.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$159.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$119.53
|
| Rate for Payer: SOMOS Essential |
$119.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$159.37
|
|
|
PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
|
Professional
|
Both
|
$37.24
|
|
|
Service Code
|
HCPCS 93270
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$21.49 |
| Rate for Payer: Cash Price |
$10.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.16
|
| Rate for Payer: Healthfirst Commercial |
$9.55
|
| Rate for Payer: Healthfirst Essential Plan |
$21.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.07
|
| Rate for Payer: Healthfirst QHP |
$9.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.55
|
| 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 |
$9.55
|
|
