|
PR BREATHING RESPONSE TO HYPOXIA
|
Professional
|
Both
|
$78.58
|
|
|
Service Code
|
HCPCS 94450 26
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$48.62 |
| Rate for Payer: Cash Price |
$20.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.21
|
| Rate for Payer: Healthfirst Commercial |
$21.61
|
| Rate for Payer: Healthfirst Essential Plan |
$48.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.53
|
| Rate for Payer: Healthfirst QHP |
$21.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.21
|
| Rate for Payer: SOMOS Essential |
$16.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.61
|
|
|
PR BREATHING RESPONSE TO HYPOXIA
|
Professional
|
Both
|
$271.43
|
|
|
Service Code
|
HCPCS 94450 TC
|
| Min. Negotiated Rate |
$55.75 |
| Max. Negotiated Rate |
$179.19 |
| Rate for Payer: Cash Price |
$71.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.73
|
| Rate for Payer: Healthfirst Commercial |
$79.64
|
| Rate for Payer: Healthfirst Essential Plan |
$179.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.66
|
| Rate for Payer: Healthfirst QHP |
$79.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.73
|
| Rate for Payer: SOMOS Essential |
$59.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.64
|
|
|
PR BRIEF ALCOHOL MISUSE COUNSEL
|
Professional
|
Both
|
$94.61
|
|
|
Service Code
|
HCPCS G0443
|
| Min. Negotiated Rate |
$23.26 |
| Max. Negotiated Rate |
$74.77 |
| Rate for Payer: Cash Price |
$25.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.92
|
| Rate for Payer: Healthfirst Commercial |
$33.23
|
| Rate for Payer: Healthfirst Essential Plan |
$74.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.57
|
| Rate for Payer: Healthfirst QHP |
$33.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.92
|
| Rate for Payer: SOMOS Essential |
$24.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.23
|
|
|
PR BRIEF CHECK IN BY MD/QHP
|
Professional
|
Both
|
$51.17
|
|
|
Service Code
|
HCPCS G2012
|
| Rate for Payer: Cash Price |
$14.29
|
|
|
PR BRIEF CHKIN, 5-10, NON-E/M
|
Professional
|
Both
|
$51.17
|
|
|
Service Code
|
HCPCS G2251
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$31.77 |
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.59
|
| Rate for Payer: Healthfirst Commercial |
$14.12
|
| Rate for Payer: Healthfirst Essential Plan |
$31.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.41
|
| Rate for Payer: Healthfirst QHP |
$14.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.59
|
| Rate for Payer: SOMOS Essential |
$10.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.12
|
|
|
PR BRIEF CHKIN BY MD/QHP, 11-20
|
Professional
|
Both
|
$103.74
|
|
|
Service Code
|
HCPCS G2252
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$62.15 |
| Rate for Payer: Amida Care Medicaid |
$14.56
|
| Rate for Payer: Cash Price |
$27.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.71
|
| Rate for Payer: Healthfirst Commercial |
$27.62
|
| Rate for Payer: Healthfirst Essential Plan |
$62.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.24
|
| Rate for Payer: Healthfirst QHP |
$27.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.71
|
| Rate for Payer: SOMOS Essential |
$20.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.62
|
|
|
PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN
|
Professional
|
Both
|
$40.36
|
|
|
Service Code
|
HCPCS 94060 26
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Amida Care Medicaid |
$46.86
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.18
|
| Rate for Payer: Healthfirst Commercial |
$10.91
|
| Rate for Payer: Healthfirst Essential Plan |
$24.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.36
|
| Rate for Payer: Healthfirst QHP |
$10.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$7.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$10.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.18
|
| Rate for Payer: SOMOS Essential |
$8.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.91
|
|
|
PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN
|
Professional
|
Both
|
$123.48
|
|
|
Service Code
|
HCPCS 94060 TC
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Amida Care Medicaid |
$46.86
|
| Rate for Payer: Cash Price |
$34.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.50
|
| Rate for Payer: Healthfirst Commercial |
$34.00
|
| Rate for Payer: Healthfirst Essential Plan |
$76.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.30
|
| Rate for Payer: Healthfirst QHP |
$34.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.50
|
| Rate for Payer: SOMOS Essential |
$25.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.00
|
|
|
PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN
|
Professional
|
Both
|
$163.84
|
|
|
Service Code
|
HCPCS 94060
|
| Min. Negotiated Rate |
$31.44 |
| Max. Negotiated Rate |
$101.05 |
| Rate for Payer: Amida Care Medicaid |
$46.86
|
| Rate for Payer: Cash Price |
$45.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.68
|
| Rate for Payer: Healthfirst Commercial |
$44.91
|
| Rate for Payer: Healthfirst Essential Plan |
$101.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.66
|
| Rate for Payer: Healthfirst QHP |
$44.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.68
|
| Rate for Payer: SOMOS Essential |
$33.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.91
|
|
|
PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS
|
Professional
|
Both
|
$531.90
|
|
|
Service Code
|
HCPCS 31623
|
| Min. Negotiated Rate |
$101.09 |
| Max. Negotiated Rate |
$324.92 |
| Rate for Payer: Cash Price |
$145.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$137.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$137.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$144.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.31
|
| Rate for Payer: Healthfirst Commercial |
$144.41
|
| Rate for Payer: Healthfirst Essential Plan |
$324.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$137.19
|
| Rate for Payer: Healthfirst QHP |
$144.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$101.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$144.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$101.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$108.31
|
| Rate for Payer: SOMOS Essential |
$108.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.41
|
|
|
PR BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX
|
Professional
|
Both
|
$896.35
|
|
|
Service Code
|
HCPCS 31652
|
| Min. Negotiated Rate |
$169.36 |
| Max. Negotiated Rate |
$544.37 |
| Rate for Payer: Cash Price |
$243.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$241.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$217.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$217.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$229.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$241.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$229.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$241.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$241.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$181.46
|
| Rate for Payer: Healthfirst Commercial |
$241.94
|
| Rate for Payer: Healthfirst Essential Plan |
$544.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$229.84
|
| Rate for Payer: Healthfirst QHP |
$241.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$169.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$241.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$205.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$169.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$241.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$181.46
|
| Rate for Payer: SOMOS Essential |
$181.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$241.94
|
|
|
PR BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX
|
Professional
|
Both
|
$994.21
|
|
|
Service Code
|
HCPCS 31653
|
| Min. Negotiated Rate |
$187.82 |
| Max. Negotiated Rate |
$603.70 |
| Rate for Payer: Cash Price |
$270.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$268.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$241.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$268.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$268.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$201.23
|
| Rate for Payer: Healthfirst Commercial |
$268.31
|
| Rate for Payer: Healthfirst Essential Plan |
$603.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$254.89
|
| Rate for Payer: Healthfirst QHP |
$268.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$187.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$268.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$228.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$187.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$268.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$201.23
|
| Rate for Payer: SOMOS Essential |
$201.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$268.31
|
|
|
PR BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX
|
Professional
|
Both
|
$544.29
|
|
|
Service Code
|
HCPCS 31622
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$330.75 |
| Rate for Payer: Cash Price |
$149.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.25
|
| Rate for Payer: Healthfirst Commercial |
$147.00
|
| Rate for Payer: Healthfirst Essential Plan |
$330.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.65
|
| Rate for Payer: Healthfirst QHP |
$147.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.25
|
| Rate for Payer: SOMOS Essential |
$110.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.00
|
|
|
PR BRNCHSC OCCLUSION&INSERT BRONCH VALVE ADDL LOBE
|
Professional
|
Both
|
$314.86
|
|
|
Service Code
|
HCPCS 31651
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Cash Price |
$83.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.04
|
| Rate for Payer: Healthfirst Commercial |
$82.72
|
| Rate for Payer: Healthfirst Essential Plan |
$186.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.58
|
| Rate for Payer: Healthfirst QHP |
$82.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.04
|
| Rate for Payer: SOMOS Essential |
$62.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.72
|
|
|
PR BRNCHSC OCCLUSION&INSERT BRONCH VALVE INIT LOBE
|
Professional
|
Both
|
$830.90
|
|
|
Service Code
|
HCPCS 31647
|
| Min. Negotiated Rate |
$157.28 |
| Max. Negotiated Rate |
$505.53 |
| Rate for Payer: Cash Price |
$226.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$224.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$202.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$202.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$213.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$224.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$213.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.51
|
| Rate for Payer: Healthfirst Commercial |
$224.68
|
| Rate for Payer: Healthfirst Essential Plan |
$505.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$213.45
|
| Rate for Payer: Healthfirst QHP |
$224.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$224.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$224.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.51
|
| Rate for Payer: SOMOS Essential |
$168.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.68
|
|
|
PR BRNCHSC REMOVAL BRONCHIAL VALVE EA ADDL
|
Professional
|
Both
|
$267.96
|
|
|
Service Code
|
HCPCS 31649
|
| Min. Negotiated Rate |
$52.85 |
| Max. Negotiated Rate |
$169.88 |
| Rate for Payer: Cash Price |
$72.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.62
|
| Rate for Payer: Healthfirst Commercial |
$75.50
|
| Rate for Payer: Healthfirst Essential Plan |
$169.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.72
|
| Rate for Payer: Healthfirst QHP |
$75.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.62
|
| Rate for Payer: SOMOS Essential |
$56.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.50
|
|
|
PR BRNCHSC REMOVAL BRONCHIAL VALVE INITIAL
|
Professional
|
Both
|
$798.67
|
|
|
Service Code
|
HCPCS 31648
|
| Min. Negotiated Rate |
$150.61 |
| Max. Negotiated Rate |
$484.11 |
| Rate for Payer: Cash Price |
$219.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$215.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$193.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$193.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$204.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$215.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$204.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$215.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$215.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.37
|
| Rate for Payer: Healthfirst Commercial |
$215.16
|
| Rate for Payer: Healthfirst Essential Plan |
$484.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$204.40
|
| Rate for Payer: Healthfirst QHP |
$215.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$150.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$215.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$182.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$150.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$215.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$161.37
|
| Rate for Payer: SOMOS Essential |
$161.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$215.16
|
|
|
PR BRNCHSC REVJ TRACHEAL/BRNCL STENT INS PREV SESS
|
Professional
|
Both
|
$1,012.38
|
|
|
Service Code
|
HCPCS 31638
|
| Min. Negotiated Rate |
$189.85 |
| Max. Negotiated Rate |
$610.25 |
| Rate for Payer: Cash Price |
$272.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$271.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$244.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$244.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$257.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$257.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$203.41
|
| Rate for Payer: Healthfirst Commercial |
$271.22
|
| Rate for Payer: Healthfirst Essential Plan |
$610.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$257.66
|
| Rate for Payer: Healthfirst QHP |
$271.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$189.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$271.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$230.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$189.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$203.41
|
| Rate for Payer: SOMOS Essential |
$203.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$271.22
|
|
|
PR BRNCHSC W/BRNCL ALVEOLAR LAVAGE
|
Professional
|
Both
|
$545.86
|
|
|
Service Code
|
HCPCS 31624
|
| Min. Negotiated Rate |
$102.88 |
| Max. Negotiated Rate |
$330.68 |
| Rate for Payer: Cash Price |
$147.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.23
|
| Rate for Payer: Healthfirst Commercial |
$146.97
|
| Rate for Payer: Healthfirst Essential Plan |
$330.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.62
|
| Rate for Payer: Healthfirst QHP |
$146.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.23
|
| Rate for Payer: SOMOS Essential |
$110.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.97
|
|
|
PR BRNCHSC W/DSTRJ TUM RELIEF STENOSIS OTH/THN EXC
|
Professional
|
Both
|
$1,044.02
|
|
|
Service Code
|
HCPCS 31641
|
| Min. Negotiated Rate |
$194.31 |
| Max. Negotiated Rate |
$624.58 |
| Rate for Payer: Cash Price |
$282.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$277.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$249.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$263.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$277.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$263.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$277.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$277.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.19
|
| Rate for Payer: Healthfirst Commercial |
$277.59
|
| Rate for Payer: Healthfirst Essential Plan |
$624.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$263.71
|
| Rate for Payer: Healthfirst QHP |
$277.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$277.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$235.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$277.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.19
|
| Rate for Payer: SOMOS Essential |
$208.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$277.59
|
|
|
PR BRNCHSC W/PLACEMENT BRNCL STENT 1ST BRONCHUS
|
Professional
|
Both
|
$884.66
|
|
|
Service Code
|
HCPCS 31636
|
| Min. Negotiated Rate |
$168.48 |
| Max. Negotiated Rate |
$541.53 |
| Rate for Payer: Cash Price |
$240.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$240.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$216.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$216.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$228.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$240.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$228.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$240.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.51
|
| Rate for Payer: Healthfirst Commercial |
$240.68
|
| Rate for Payer: Healthfirst Essential Plan |
$541.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$228.65
|
| Rate for Payer: Healthfirst QHP |
$240.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$168.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$240.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$204.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$168.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$240.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$180.51
|
| Rate for Payer: SOMOS Essential |
$180.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$240.68
|
|
|
PR BRNCHSC W/PLMT CATH INTRCV RADIOELMNT APPL
|
Professional
|
Both
|
$680.61
|
|
|
Service Code
|
HCPCS 31643
|
| Min. Negotiated Rate |
$129.15 |
| Max. Negotiated Rate |
$415.12 |
| Rate for Payer: Cash Price |
$185.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.38
|
| Rate for Payer: Healthfirst Commercial |
$184.50
|
| Rate for Payer: Healthfirst Essential Plan |
$415.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.28
|
| Rate for Payer: Healthfirst QHP |
$184.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.38
|
| Rate for Payer: SOMOS Essential |
$138.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.50
|
|
|
PR BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX
|
Professional
|
Both
|
$822.99
|
|
|
Service Code
|
HCPCS 31630
|
| Min. Negotiated Rate |
$154.87 |
| Max. Negotiated Rate |
$497.79 |
| Rate for Payer: Cash Price |
$222.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$221.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$199.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$199.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$210.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$221.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$210.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$221.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.93
|
| Rate for Payer: Healthfirst Commercial |
$221.24
|
| Rate for Payer: Healthfirst Essential Plan |
$497.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.18
|
| Rate for Payer: Healthfirst QHP |
$221.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$221.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$188.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$221.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.93
|
| Rate for Payer: SOMOS Essential |
$165.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.24
|
|
|
PR BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT
|
Professional
|
Both
|
$107.94
|
|
|
Service Code
|
HCPCS 94070 26
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$65.88 |
| Rate for Payer: Amida Care Medicaid |
$47.16
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.96
|
| Rate for Payer: Healthfirst Commercial |
$29.28
|
| Rate for Payer: Healthfirst Essential Plan |
$65.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.82
|
| Rate for Payer: Healthfirst QHP |
$29.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.96
|
| Rate for Payer: SOMOS Essential |
$21.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.28
|
|
|
PR BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT
|
Professional
|
Both
|
$146.48
|
|
|
Service Code
|
HCPCS 94070 TC
|
| Min. Negotiated Rate |
$29.94 |
| Max. Negotiated Rate |
$96.23 |
| Rate for Payer: Amida Care Medicaid |
$47.16
|
| Rate for Payer: Cash Price |
$42.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.08
|
| Rate for Payer: Healthfirst Commercial |
$42.77
|
| Rate for Payer: Healthfirst Essential Plan |
$96.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.63
|
| Rate for Payer: Healthfirst QHP |
$42.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.08
|
| Rate for Payer: SOMOS Essential |
$32.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.77
|
|
