|
PR CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE
|
Professional
|
Both
|
$3,589.57
|
|
|
Service Code
|
HCPCS 27435
|
| Min. Negotiated Rate |
$674.32 |
| Max. Negotiated Rate |
$2,167.47 |
| Rate for Payer: Cash Price |
$967.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$963.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$866.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$866.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$915.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$963.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$915.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$963.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$963.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$722.49
|
| Rate for Payer: Healthfirst Commercial |
$963.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,167.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$915.15
|
| Rate for Payer: Healthfirst QHP |
$963.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$674.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$963.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$818.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$674.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$963.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$722.49
|
| Rate for Payer: SOMOS Essential |
$722.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$963.32
|
|
|
PR CAPSULOTOMY WRIST
|
Professional
|
Both
|
$1,984.40
|
|
|
Service Code
|
HCPCS 25085
|
| Min. Negotiated Rate |
$377.62 |
| Max. Negotiated Rate |
$1,213.76 |
| Rate for Payer: Cash Price |
$541.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$539.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$485.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$485.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$512.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$539.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$512.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$539.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$404.59
|
| Rate for Payer: Healthfirst Commercial |
$539.45
|
| Rate for Payer: Healthfirst Essential Plan |
$1,213.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$512.48
|
| Rate for Payer: Healthfirst QHP |
$539.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$377.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$539.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$458.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$377.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$539.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$404.59
|
| Rate for Payer: SOMOS Essential |
$404.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$539.45
|
|
|
PR CARDIOASSIST-METH CIRCULATORY ASSIST EXTERNAL
|
Professional
|
Both
|
$440.37
|
|
|
Service Code
|
HCPCS 92971
|
| Min. Negotiated Rate |
$51.65 |
| Max. Negotiated Rate |
$259.56 |
| Rate for Payer: Amida Care Medicaid |
$51.65
|
| Rate for Payer: Cash Price |
$116.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$115.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.52
|
| Rate for Payer: Healthfirst Commercial |
$115.36
|
| Rate for Payer: Healthfirst Essential Plan |
$259.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.59
|
| Rate for Payer: Healthfirst QHP |
$115.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$115.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.52
|
| Rate for Payer: SOMOS Essential |
$86.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.36
|
|
|
PR CARDIOASSIST-METH CIRCULATORY ASSIST INTERNAL
|
Professional
|
Both
|
$826.84
|
|
|
Service Code
|
HCPCS 92970
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$490.39 |
| Rate for Payer: Amida Care Medicaid |
$89.40
|
| Rate for Payer: Cash Price |
$219.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$217.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$196.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$207.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$217.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$207.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.46
|
| Rate for Payer: Healthfirst Commercial |
$217.95
|
| Rate for Payer: Healthfirst Essential Plan |
$490.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$207.05
|
| Rate for Payer: Healthfirst QHP |
$217.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$152.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$217.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$185.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$152.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$217.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$163.46
|
| Rate for Payer: SOMOS Essential |
$163.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$217.95
|
|
|
PR CARDIOKYMOGRAPHY
|
Professional
|
Both
|
$41.55
|
|
|
Service Code
|
HCPCS Q0035 TC
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Cash Price |
$11.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.11
|
| Rate for Payer: Healthfirst Commercial |
$16.14
|
| Rate for Payer: Healthfirst Essential Plan |
$36.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.33
|
| Rate for Payer: Healthfirst QHP |
$16.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.11
|
| Rate for Payer: SOMOS Essential |
$12.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.14
|
|
|
PR CARDIOKYMOGRAPHY
|
Professional
|
Both
|
$32.66
|
|
|
Service Code
|
HCPCS Q0035 26
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.07
|
| Rate for Payer: Healthfirst Commercial |
$9.42
|
| Rate for Payer: Healthfirst Essential Plan |
$21.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.95
|
| Rate for Payer: Healthfirst QHP |
$9.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.07
|
| Rate for Payer: SOMOS Essential |
$7.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.42
|
|
|
PR CARDIOKYMOGRAPHY
|
Professional
|
Both
|
$74.20
|
|
|
Service Code
|
HCPCS Q0035
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$57.53 |
| Rate for Payer: Cash Price |
$20.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.18
|
| Rate for Payer: Healthfirst Commercial |
$25.57
|
| Rate for Payer: Healthfirst Essential Plan |
$57.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.29
|
| Rate for Payer: Healthfirst QHP |
$25.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.18
|
| Rate for Payer: SOMOS Essential |
$19.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.57
|
|
|
PR CARDIOPULMONARY EXERCISE TESTING
|
Professional
|
Both
|
$644.81
|
|
|
Service Code
|
HCPCS 94621
|
| Min. Negotiated Rate |
$124.05 |
| Max. Negotiated Rate |
$398.72 |
| Rate for Payer: Amida Care Medicaid |
$124.69
|
| Rate for Payer: Cash Price |
$178.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$177.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$159.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$159.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$168.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$177.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$168.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$177.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$177.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.91
|
| Rate for Payer: Healthfirst Commercial |
$177.21
|
| Rate for Payer: Healthfirst Essential Plan |
$398.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$168.35
|
| Rate for Payer: Healthfirst QHP |
$177.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$124.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$177.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$150.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$124.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$177.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$132.91
|
| Rate for Payer: SOMOS Essential |
$132.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$177.21
|
|
|
PR CARDIOPULMONARY EXERCISE TESTING
|
Professional
|
Both
|
$374.64
|
|
|
Service Code
|
HCPCS 94621 TC
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$233.87 |
| Rate for Payer: Amida Care Medicaid |
$124.69
|
| Rate for Payer: Cash Price |
$104.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.95
|
| Rate for Payer: Healthfirst Commercial |
$103.94
|
| Rate for Payer: Healthfirst Essential Plan |
$233.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.74
|
| Rate for Payer: Healthfirst QHP |
$103.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.95
|
| Rate for Payer: SOMOS Essential |
$77.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.94
|
|
|
PR CARDIOPULMONARY EXERCISE TESTING
|
Professional
|
Both
|
$270.17
|
|
|
Service Code
|
HCPCS 94621 26
|
| Min. Negotiated Rate |
$51.29 |
| Max. Negotiated Rate |
$164.86 |
| Rate for Payer: Amida Care Medicaid |
$124.69
|
| Rate for Payer: Cash Price |
$73.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.95
|
| Rate for Payer: Healthfirst Commercial |
$73.27
|
| Rate for Payer: Healthfirst Essential Plan |
$164.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.61
|
| Rate for Payer: Healthfirst QHP |
$73.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.95
|
| Rate for Payer: SOMOS Essential |
$54.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.27
|
|
|
PR CARDIOPULMONARY RESUSCITATION
|
Professional
|
Both
|
$748.72
|
|
|
Service Code
|
HCPCS 92950
|
| Min. Negotiated Rate |
$88.46 |
| Max. Negotiated Rate |
$455.62 |
| Rate for Payer: Amida Care Medicaid |
$88.46
|
| Rate for Payer: Cash Price |
$204.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$202.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$182.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$192.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$202.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$192.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$202.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$151.88
|
| Rate for Payer: Healthfirst Commercial |
$202.50
|
| Rate for Payer: Healthfirst Essential Plan |
$455.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$192.38
|
| Rate for Payer: Healthfirst QHP |
$202.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$141.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$172.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$141.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$202.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$151.88
|
| Rate for Payer: SOMOS Essential |
$151.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$202.50
|
|
|
PR CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP
|
Professional
|
Both
|
$8,493.21
|
|
|
Service Code
|
HCPCS 33315
|
| Min. Negotiated Rate |
$1,557.09 |
| Max. Negotiated Rate |
$5,004.92 |
| Rate for Payer: Cash Price |
$2,257.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,224.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,001.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,001.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,113.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,224.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,113.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,224.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,224.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,668.31
|
| Rate for Payer: Healthfirst Commercial |
$2,224.41
|
| Rate for Payer: Healthfirst Essential Plan |
$5,004.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,113.19
|
| Rate for Payer: Healthfirst QHP |
$2,224.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,557.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,224.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,890.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,557.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,224.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,668.31
|
| Rate for Payer: SOMOS Essential |
$1,668.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,224.41
|
|
|
PR CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP
|
Professional
|
Both
|
$5,157.57
|
|
|
Service Code
|
HCPCS 33310
|
| Min. Negotiated Rate |
$954.16 |
| Max. Negotiated Rate |
$3,066.95 |
| Rate for Payer: Cash Price |
$1,371.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,363.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,226.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,226.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,294.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,363.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,294.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,363.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,363.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,022.32
|
| Rate for Payer: Healthfirst Commercial |
$1,363.09
|
| Rate for Payer: Healthfirst Essential Plan |
$3,066.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,294.94
|
| Rate for Payer: Healthfirst QHP |
$1,363.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$954.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,363.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,158.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$954.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,363.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,022.32
|
| Rate for Payer: SOMOS Essential |
$1,022.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,363.09
|
|
|
PR CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR
|
Professional
|
Both
|
$358.09
|
|
|
Service Code
|
HCPCS 93660 26
|
| Min. Negotiated Rate |
$67.84 |
| Max. Negotiated Rate |
$218.07 |
| Rate for Payer: Amida Care Medicaid |
$135.04
|
| Rate for Payer: Cash Price |
$97.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.69
|
| Rate for Payer: Healthfirst Commercial |
$96.92
|
| Rate for Payer: Healthfirst Essential Plan |
$218.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.07
|
| Rate for Payer: Healthfirst QHP |
$96.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.69
|
| Rate for Payer: SOMOS Essential |
$72.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.92
|
|
|
PR CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR
|
Professional
|
Both
|
$665.14
|
|
|
Service Code
|
HCPCS 93660
|
| Min. Negotiated Rate |
$129.19 |
| Max. Negotiated Rate |
$415.26 |
| Rate for Payer: Amida Care Medicaid |
$135.04
|
| Rate for Payer: Cash Price |
$184.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.42
|
| Rate for Payer: Healthfirst Commercial |
$184.56
|
| Rate for Payer: Healthfirst Essential Plan |
$415.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.33
|
| Rate for Payer: Healthfirst QHP |
$184.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.42
|
| Rate for Payer: SOMOS Essential |
$138.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.56
|
|
|
PR CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR
|
Professional
|
Both
|
$307.06
|
|
|
Service Code
|
HCPCS 93660 TC
|
| Min. Negotiated Rate |
$61.35 |
| Max. Negotiated Rate |
$197.19 |
| Rate for Payer: Amida Care Medicaid |
$135.04
|
| Rate for Payer: Cash Price |
$86.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.73
|
| Rate for Payer: Healthfirst Commercial |
$87.64
|
| Rate for Payer: Healthfirst Essential Plan |
$197.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.26
|
| Rate for Payer: Healthfirst QHP |
$87.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.73
|
| Rate for Payer: SOMOS Essential |
$65.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.64
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX
|
Professional
|
Both
|
$1,067.12
|
|
|
Service Code
|
HCPCS 92961
|
| Min. Negotiated Rate |
$131.10 |
| Max. Negotiated Rate |
$631.85 |
| Rate for Payer: Amida Care Medicaid |
$131.10
|
| Rate for Payer: Cash Price |
$284.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$280.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$252.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$266.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$280.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$266.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$280.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$280.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$210.62
|
| Rate for Payer: Healthfirst Commercial |
$280.82
|
| Rate for Payer: Healthfirst Essential Plan |
$631.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$266.78
|
| Rate for Payer: Healthfirst QHP |
$280.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$196.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$280.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$238.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$196.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$280.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$210.62
|
| Rate for Payer: SOMOS Essential |
$210.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$280.82
|
|
|
PR CARDIOVERSION, ELECTIVE;EXTERN
|
Professional
|
Both
|
$443.63
|
|
|
Service Code
|
HCPCS 92960
|
| Min. Negotiated Rate |
$67.07 |
| Max. Negotiated Rate |
$268.96 |
| Rate for Payer: Amida Care Medicaid |
$67.07
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.66
|
| Rate for Payer: Healthfirst Commercial |
$119.54
|
| Rate for Payer: Healthfirst Essential Plan |
$268.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.56
|
| Rate for Payer: Healthfirst QHP |
$119.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.66
|
| Rate for Payer: SOMOS Essential |
$89.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.54
|
|
|
PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Professional
|
Both
|
$11.52
|
|
|
Service Code
|
HCPCS 96161
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.62
|
| Rate for Payer: Healthfirst Commercial |
$3.49
|
| Rate for Payer: Healthfirst Essential Plan |
$7.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.32
|
| Rate for Payer: Healthfirst QHP |
$3.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.62
|
| Rate for Payer: SOMOS Essential |
$2.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.49
|
|
|
PR CARE MANAGE BEH SVS 20MINS
|
Professional
|
Both
|
$117.53
|
|
|
Service Code
|
HCPCS G0323
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$103.84 |
| Rate for Payer: Cash Price |
$48.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.61
|
| Rate for Payer: Healthfirst Commercial |
$46.15
|
| Rate for Payer: Healthfirst Essential Plan |
$103.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.84
|
| Rate for Payer: Healthfirst QHP |
$46.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.61
|
| Rate for Payer: SOMOS Essential |
$34.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.15
|
|
|
PR CARE MANAG H VST NEW PT 20 M
|
Professional
|
Both
|
$194.95
|
|
|
Service Code
|
HCPCS G0076
|
| Min. Negotiated Rate |
$37.77 |
| Max. Negotiated Rate |
$121.41 |
| Rate for Payer: Cash Price |
$54.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.47
|
| Rate for Payer: Healthfirst Commercial |
$53.96
|
| Rate for Payer: Healthfirst Essential Plan |
$121.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.26
|
| Rate for Payer: Healthfirst QHP |
$53.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.47
|
| Rate for Payer: SOMOS Essential |
$40.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.96
|
|
|
PR CARE MANAG H VST NEW PT 30 M
|
Professional
|
Both
|
$294.21
|
|
|
Service Code
|
HCPCS G0077
|
| Min. Negotiated Rate |
$56.53 |
| Max. Negotiated Rate |
$181.71 |
| Rate for Payer: Cash Price |
$81.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.57
|
| Rate for Payer: Healthfirst Commercial |
$80.76
|
| Rate for Payer: Healthfirst Essential Plan |
$181.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.72
|
| Rate for Payer: Healthfirst QHP |
$80.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.57
|
| Rate for Payer: SOMOS Essential |
$60.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.76
|
|
|
PR CARE MANAG H VST NEW PT 45 M
|
Professional
|
Both
|
$486.26
|
|
|
Service Code
|
HCPCS G0078
|
| Min. Negotiated Rate |
$92.29 |
| Max. Negotiated Rate |
$296.64 |
| Rate for Payer: Cash Price |
$133.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.88
|
| Rate for Payer: Healthfirst Commercial |
$131.84
|
| Rate for Payer: Healthfirst Essential Plan |
$296.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.25
|
| Rate for Payer: Healthfirst QHP |
$131.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.88
|
| Rate for Payer: SOMOS Essential |
$98.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.84
|
|
|
PR CARE MANAG H VST NEW PT 60 M
|
Professional
|
Both
|
$645.09
|
|
|
Service Code
|
HCPCS G0079
|
| Min. Negotiated Rate |
$121.04 |
| Max. Negotiated Rate |
$389.05 |
| Rate for Payer: Cash Price |
$175.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.68
|
| Rate for Payer: Healthfirst Commercial |
$172.91
|
| Rate for Payer: Healthfirst Essential Plan |
$389.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.26
|
| Rate for Payer: Healthfirst QHP |
$172.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$172.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.68
|
| Rate for Payer: SOMOS Essential |
$129.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.91
|
|
|
PR CARE MANAG H VST NEW PT 75 M
|
Professional
|
Both
|
$846.62
|
|
|
Service Code
|
HCPCS G0080
|
| Min. Negotiated Rate |
$159.99 |
| Max. Negotiated Rate |
$514.24 |
| Rate for Payer: Cash Price |
$232.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$217.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$217.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.41
|
| Rate for Payer: Healthfirst Commercial |
$228.55
|
| Rate for Payer: Healthfirst Essential Plan |
$514.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$217.12
|
| Rate for Payer: Healthfirst QHP |
$228.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$194.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.41
|
| Rate for Payer: SOMOS Essential |
$171.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.55
|
|
