|
PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM
|
Professional
|
Both
|
$3,222.80
|
|
|
Service Code
|
HCPCS 14041
|
| Min. Negotiated Rate |
$615.20 |
| Max. Negotiated Rate |
$1,977.41 |
| Rate for Payer: Cash Price |
$880.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$878.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$790.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$790.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$834.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$878.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$834.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$878.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$878.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$659.14
|
| Rate for Payer: Healthfirst Commercial |
$878.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,977.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$834.91
|
| Rate for Payer: Healthfirst QHP |
$878.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$615.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$878.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$747.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$615.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$878.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$659.14
|
| Rate for Payer: SOMOS Essential |
$659.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$878.85
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$3,020.40
|
|
|
Service Code
|
HCPCS 14021
|
| Min. Negotiated Rate |
$575.98 |
| Max. Negotiated Rate |
$1,851.37 |
| Rate for Payer: Cash Price |
$824.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$822.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$740.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$740.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$781.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$822.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$781.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$822.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$822.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$617.12
|
| Rate for Payer: Healthfirst Commercial |
$822.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,851.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$781.69
|
| Rate for Payer: Healthfirst QHP |
$822.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$575.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$822.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$699.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$575.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$822.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$617.12
|
| Rate for Payer: SOMOS Essential |
$617.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$822.83
|
|
|
PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$3,458.49
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$659.43 |
| Max. Negotiated Rate |
$2,119.61 |
| Rate for Payer: Cash Price |
$946.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$942.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$847.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$847.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$894.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$942.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$894.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$942.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$942.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$706.54
|
| Rate for Payer: Healthfirst Commercial |
$942.05
|
| Rate for Payer: Healthfirst Essential Plan |
$2,119.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$894.95
|
| Rate for Payer: Healthfirst QHP |
$942.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$659.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$942.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$800.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$659.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$942.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$706.54
|
| Rate for Payer: SOMOS Essential |
$706.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$942.05
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$936.71
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$173.94 |
| Max. Negotiated Rate |
$559.08 |
| Rate for Payer: Cash Price |
$250.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$248.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$223.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$223.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$236.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$248.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$236.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$248.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$248.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$186.36
|
| Rate for Payer: Healthfirst Commercial |
$248.48
|
| Rate for Payer: Healthfirst Essential Plan |
$559.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$236.06
|
| Rate for Payer: Healthfirst QHP |
$248.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$173.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$248.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$211.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$173.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$248.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$186.36
|
| Rate for Payer: SOMOS Essential |
$186.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$248.48
|
|
|
PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$2,421.06
|
|
|
Service Code
|
HCPCS 14020
|
| Min. Negotiated Rate |
$462.13 |
| Max. Negotiated Rate |
$1,485.40 |
| Rate for Payer: Cash Price |
$662.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$660.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$594.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$594.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$627.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$660.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$627.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$660.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$660.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$495.13
|
| Rate for Payer: Healthfirst Commercial |
$660.18
|
| Rate for Payer: Healthfirst Essential Plan |
$1,485.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$627.17
|
| Rate for Payer: Healthfirst QHP |
$660.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$462.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$660.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$561.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$462.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$660.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$495.13
|
| Rate for Payer: SOMOS Essential |
$495.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$660.18
|
|
|
PR ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Professional
|
Both
|
$2,816.63
|
|
|
Service Code
|
HCPCS 14060
|
| Min. Negotiated Rate |
$536.50 |
| Max. Negotiated Rate |
$1,724.47 |
| Rate for Payer: Cash Price |
$769.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$766.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$689.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$689.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$728.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$766.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$728.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$766.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$766.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$574.82
|
| Rate for Payer: Healthfirst Commercial |
$766.43
|
| Rate for Payer: Healthfirst Essential Plan |
$1,724.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$728.11
|
| Rate for Payer: Healthfirst QHP |
$766.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$536.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$766.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$651.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$536.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$766.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$574.82
|
| Rate for Payer: SOMOS Essential |
$574.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$766.43
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$2,648.87
|
|
|
Service Code
|
HCPCS 14040
|
| Min. Negotiated Rate |
$505.11 |
| Max. Negotiated Rate |
$1,623.58 |
| Rate for Payer: Cash Price |
$724.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$721.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$649.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$649.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$685.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$721.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$685.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$721.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$721.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$541.19
|
| Rate for Payer: Healthfirst Commercial |
$721.59
|
| Rate for Payer: Healthfirst Essential Plan |
$1,623.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$685.51
|
| Rate for Payer: Healthfirst QHP |
$721.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$505.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$721.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$613.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$505.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$721.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$541.19
|
| Rate for Payer: SOMOS Essential |
$541.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$721.59
|
|
|
PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES
|
Professional
|
Both
|
$1,924.41
|
|
|
Service Code
|
HCPCS 20693
|
| Min. Negotiated Rate |
$373.13 |
| Max. Negotiated Rate |
$1,199.34 |
| Rate for Payer: Cash Price |
$530.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$533.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$479.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$479.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$506.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$533.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$506.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$533.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$533.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$399.78
|
| Rate for Payer: Healthfirst Commercial |
$533.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,199.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$506.39
|
| Rate for Payer: Healthfirst QHP |
$533.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$373.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$533.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$453.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$373.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$533.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$399.78
|
| Rate for Payer: SOMOS Essential |
$399.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$533.04
|
|
|
PR ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR
|
Professional
|
Both
|
$5,565.28
|
|
|
Service Code
|
HCPCS 60545
|
| Min. Negotiated Rate |
$1,027.85 |
| Max. Negotiated Rate |
$3,303.81 |
| Rate for Payer: Cash Price |
$1,491.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,468.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,321.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,321.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,394.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,468.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,394.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,468.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,468.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,101.27
|
| Rate for Payer: Healthfirst Commercial |
$1,468.36
|
| Rate for Payer: Healthfirst Essential Plan |
$3,303.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,394.94
|
| Rate for Payer: Healthfirst QHP |
$1,468.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,027.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,468.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,248.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,027.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,468.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,101.27
|
| Rate for Payer: SOMOS Essential |
$1,101.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,468.36
|
|
|
PR ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX
|
Professional
|
Both
|
$4,764.97
|
|
|
Service Code
|
HCPCS 60540
|
| Min. Negotiated Rate |
$889.64 |
| Max. Negotiated Rate |
$2,859.57 |
| Rate for Payer: Cash Price |
$1,281.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,270.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,143.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,143.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,207.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,270.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,207.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,270.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,270.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$953.19
|
| Rate for Payer: Healthfirst Commercial |
$1,270.92
|
| Rate for Payer: Healthfirst Essential Plan |
$2,859.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,207.37
|
| Rate for Payer: Healthfirst QHP |
$1,270.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$889.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,270.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,080.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$889.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,270.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$953.19
|
| Rate for Payer: SOMOS Essential |
$953.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,270.92
|
|
|
PR ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Professional
|
Both
|
$290.40
|
|
|
Service Code
|
HCPCS 99498
|
| Min. Negotiated Rate |
$54.94 |
| Max. Negotiated Rate |
$176.58 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$78.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.86
|
| Rate for Payer: Healthfirst Commercial |
$78.48
|
| Rate for Payer: Healthfirst Essential Plan |
$176.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.56
|
| Rate for Payer: Healthfirst QHP |
$78.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.86
|
| Rate for Payer: SOMOS Essential |
$58.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.48
|
|
|
PR ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
Both
|
$305.80
|
|
|
Service Code
|
HCPCS 99497
|
| Min. Negotiated Rate |
$57.89 |
| Max. Negotiated Rate |
$186.07 |
| Rate for Payer: Cash Price |
$83.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.02
|
| Rate for Payer: Healthfirst Commercial |
$82.70
|
| Rate for Payer: Healthfirst Essential Plan |
$186.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.56
|
| Rate for Payer: Healthfirst QHP |
$82.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.02
|
| Rate for Payer: SOMOS Essential |
$62.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.70
|
|
|
PR AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Professional
|
Both
|
$350.39
|
|
|
Service Code
|
HCPCS 92651
|
| Min. Negotiated Rate |
$46.91 |
| Max. Negotiated Rate |
$199.24 |
| Rate for Payer: Amida Care Medicaid |
$46.91
|
| Rate for Payer: Cash Price |
$94.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$88.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.41
|
| Rate for Payer: Healthfirst Commercial |
$88.55
|
| Rate for Payer: Healthfirst Essential Plan |
$199.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.12
|
| Rate for Payer: Healthfirst QHP |
$88.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.41
|
| Rate for Payer: SOMOS Essential |
$66.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.55
|
|
|
PR AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT
|
Professional
|
Both
|
$350.63
|
|
|
Service Code
|
HCPCS 92653
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$204.50 |
| Rate for Payer: Amida Care Medicaid |
$45.76
|
| Rate for Payer: Cash Price |
$94.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$90.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$81.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$81.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$90.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.17
|
| Rate for Payer: Healthfirst Commercial |
$90.89
|
| Rate for Payer: Healthfirst Essential Plan |
$204.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.35
|
| Rate for Payer: Healthfirst QHP |
$90.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$63.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$90.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$63.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$90.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.17
|
| Rate for Payer: SOMOS Essential |
$68.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$90.89
|
|
|
PR AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Professional
|
Both
|
$468.51
|
|
|
Service Code
|
HCPCS 92652
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$272.72 |
| Rate for Payer: Amida Care Medicaid |
$62.00
|
| Rate for Payer: Cash Price |
$127.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$121.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$109.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$109.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$121.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.91
|
| Rate for Payer: Healthfirst Commercial |
$121.21
|
| Rate for Payer: Healthfirst Essential Plan |
$272.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$115.15
|
| Rate for Payer: Healthfirst QHP |
$121.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$121.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$103.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$121.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.91
|
| Rate for Payer: SOMOS Essential |
$90.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$121.21
|
|
|
PR AGMNTJ MNDBLR BDY/ANGL W/GRF ONLAY/INTERPOSAL
|
Professional
|
Both
|
$3,196.41
|
|
|
Service Code
|
HCPCS 21127
|
| Min. Negotiated Rate |
$620.79 |
| Max. Negotiated Rate |
$1,995.39 |
| Rate for Payer: Cash Price |
$885.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$886.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$798.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$798.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$842.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$886.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$842.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$886.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$886.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$665.13
|
| Rate for Payer: Healthfirst Commercial |
$886.84
|
| Rate for Payer: Healthfirst Essential Plan |
$1,995.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$842.50
|
| Rate for Payer: Healthfirst QHP |
$886.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$620.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$886.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$753.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$620.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$886.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$665.13
|
| Rate for Payer: SOMOS Essential |
$665.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$886.84
|
|
|
PR AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL
|
Professional
|
Both
|
$2,786.21
|
|
|
Service Code
|
HCPCS 21125
|
| Min. Negotiated Rate |
$537.04 |
| Max. Negotiated Rate |
$1,726.20 |
| Rate for Payer: Cash Price |
$763.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$767.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$690.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$690.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$728.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$767.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$728.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$767.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$767.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$575.40
|
| Rate for Payer: Healthfirst Commercial |
$767.20
|
| Rate for Payer: Healthfirst Essential Plan |
$1,726.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$728.84
|
| Rate for Payer: Healthfirst QHP |
$767.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$537.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$767.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$652.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$537.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$767.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$575.40
|
| Rate for Payer: SOMOS Essential |
$575.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$767.20
|
|
|
PR AIRWAY RESISTANCE BY OSCILLOMETRY
|
Professional
|
Both
|
$119.18
|
|
|
Service Code
|
HCPCS 94728 TC
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$85.23 |
| Rate for Payer: Amida Care Medicaid |
$19.53
|
| Rate for Payer: Cash Price |
$38.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.41
|
| Rate for Payer: Healthfirst Commercial |
$37.88
|
| Rate for Payer: Healthfirst Essential Plan |
$85.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.99
|
| Rate for Payer: Healthfirst QHP |
$37.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.41
|
| Rate for Payer: SOMOS Essential |
$28.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.88
|
|
|
PR AIRWAY RESISTANCE BY OSCILLOMETRY
|
Professional
|
Both
|
$167.41
|
|
|
Service Code
|
HCPCS 94728
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$114.64 |
| Rate for Payer: Amida Care Medicaid |
$19.53
|
| Rate for Payer: Cash Price |
$51.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.21
|
| Rate for Payer: Healthfirst Commercial |
$50.95
|
| Rate for Payer: Healthfirst Essential Plan |
$114.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.40
|
| Rate for Payer: Healthfirst QHP |
$50.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.21
|
| Rate for Payer: SOMOS Essential |
$38.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.95
|
|
|
PR AIRWAY RESISTANCE BY OSCILLOMETRY
|
Professional
|
Both
|
$48.23
|
|
|
Service Code
|
HCPCS 94728 26
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$29.41 |
| Rate for Payer: Amida Care Medicaid |
$19.53
|
| Rate for Payer: Cash Price |
$13.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.80
|
| Rate for Payer: Healthfirst Commercial |
$13.07
|
| Rate for Payer: Healthfirst Essential Plan |
$29.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.42
|
| Rate for Payer: Healthfirst QHP |
$13.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.80
|
| Rate for Payer: SOMOS Essential |
$9.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.07
|
|
|
PR ALBUTEROL IPRATROP NON-COMP
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS J7620
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Cash Price |
$0.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.15
|
| Rate for Payer: Healthfirst Commercial |
$0.20
|
| Rate for Payer: Healthfirst Essential Plan |
$0.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.19
|
| Rate for Payer: Healthfirst QHP |
$0.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.15
|
| Rate for Payer: SOMOS Essential |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
PR ALBUTEROL NON-COMP CON
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J7611
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.13
|
| Rate for Payer: Healthfirst Commercial |
$0.17
|
| Rate for Payer: Healthfirst Essential Plan |
$0.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.16
|
| Rate for Payer: Healthfirst QHP |
$0.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.13
|
| Rate for Payer: SOMOS Essential |
$0.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
PR ALCOHOL/SUB ABUSE ASSESS
|
Professional
|
Both
|
$66.92
|
|
|
Service Code
|
HCPCS G2011
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$41.98 |
| Rate for Payer: Cash Price |
$18.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.99
|
| Rate for Payer: Healthfirst Commercial |
$18.66
|
| Rate for Payer: Healthfirst Essential Plan |
$41.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.73
|
| Rate for Payer: Healthfirst QHP |
$18.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.99
|
| Rate for Payer: SOMOS Essential |
$13.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.66
|
|
|
PR ALCOHOL/SUBS INTERV 15-30MN
|
Professional
|
Both
|
$126.84
|
|
|
Service Code
|
HCPCS G0396
|
| Min. Negotiated Rate |
$24.63 |
| Max. Negotiated Rate |
$79.18 |
| Rate for Payer: Cash Price |
$35.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.39
|
| Rate for Payer: Healthfirst Commercial |
$35.19
|
| Rate for Payer: Healthfirst Essential Plan |
$79.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.43
|
| Rate for Payer: Healthfirst QHP |
$35.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.39
|
| Rate for Payer: SOMOS Essential |
$26.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.19
|
|
|
PR ALCOHOL/SUBS INTERV >30 MIN
|
Professional
|
Both
|
$268.98
|
|
|
Service Code
|
HCPCS G0397
|
| Min. Negotiated Rate |
$47.42 |
| Max. Negotiated Rate |
$152.41 |
| Rate for Payer: Cash Price |
$72.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.80
|
| Rate for Payer: Healthfirst Commercial |
$67.74
|
| Rate for Payer: Healthfirst Essential Plan |
$152.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.35
|
| Rate for Payer: Healthfirst QHP |
$67.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.80
|
| Rate for Payer: SOMOS Essential |
$50.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.74
|
|
