|
PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Professional
|
Both
|
$835.24
|
|
|
Service Code
|
HCPCS 45381
|
| Min. Negotiated Rate |
$158.63 |
| Max. Negotiated Rate |
$509.87 |
| Rate for Payer: Cash Price |
$226.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$226.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.96
|
| Rate for Payer: Healthfirst Commercial |
$226.61
|
| Rate for Payer: Healthfirst Essential Plan |
$509.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.28
|
| Rate for Payer: Healthfirst QHP |
$226.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$226.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$226.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.96
|
| Rate for Payer: SOMOS Essential |
$169.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.61
|
|
|
PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX
|
Professional
|
Both
|
$1,071.04
|
|
|
Service Code
|
HCPCS 45391
|
| Min. Negotiated Rate |
$201.28 |
| Max. Negotiated Rate |
$646.99 |
| Rate for Payer: Cash Price |
$290.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$287.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$258.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$258.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$273.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$287.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$273.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$287.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$287.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.66
|
| Rate for Payer: Healthfirst Commercial |
$287.55
|
| Rate for Payer: Healthfirst Essential Plan |
$646.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$273.17
|
| Rate for Payer: Healthfirst QHP |
$287.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$201.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$287.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$244.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$201.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$287.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$215.66
|
| Rate for Payer: SOMOS Essential |
$215.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$287.55
|
|
|
PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Professional
|
Both
|
$962.99
|
|
|
Service Code
|
HCPCS 45384
|
| Min. Negotiated Rate |
$181.65 |
| Max. Negotiated Rate |
$583.88 |
| Rate for Payer: Cash Price |
$261.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$259.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$233.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$233.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$246.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$259.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$246.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$259.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$259.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$194.62
|
| Rate for Payer: Healthfirst Commercial |
$259.50
|
| Rate for Payer: Healthfirst Essential Plan |
$583.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$246.53
|
| Rate for Payer: Healthfirst QHP |
$259.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$181.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$259.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$220.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$181.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$259.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$194.62
|
| Rate for Payer: SOMOS Essential |
$194.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$259.50
|
|
|
PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
Both
|
$1,057.81
|
|
|
Service Code
|
HCPCS 45385
|
| Min. Negotiated Rate |
$199.10 |
| Max. Negotiated Rate |
$639.97 |
| Rate for Payer: Cash Price |
$287.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$284.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$255.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$255.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$270.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$284.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$270.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$284.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.32
|
| Rate for Payer: Healthfirst Commercial |
$284.43
|
| Rate for Payer: Healthfirst Essential Plan |
$639.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$270.21
|
| Rate for Payer: Healthfirst QHP |
$284.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$284.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$241.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$284.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.32
|
| Rate for Payer: SOMOS Essential |
$213.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$284.43
|
|
|
PR COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL
|
Professional
|
Both
|
$1,264.90
|
|
|
Service Code
|
HCPCS 45392
|
| Min. Negotiated Rate |
$237.22 |
| Max. Negotiated Rate |
$762.48 |
| Rate for Payer: Cash Price |
$343.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$338.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$304.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$304.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$338.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$338.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$254.16
|
| Rate for Payer: Healthfirst Commercial |
$338.88
|
| Rate for Payer: Healthfirst Essential Plan |
$762.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$321.94
|
| Rate for Payer: Healthfirst QHP |
$338.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$237.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$338.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$288.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$237.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$338.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$254.16
|
| Rate for Payer: SOMOS Essential |
$254.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$338.88
|
|
|
PR COMMUNITY/WORK REINTEGRATION TRAING EA 15 MIN
|
Professional
|
Both
|
$128.98
|
|
|
Service Code
|
HCPCS 97537
|
| Min. Negotiated Rate |
$25.32 |
| Max. Negotiated Rate |
$81.38 |
| Rate for Payer: Cash Price |
$35.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.13
|
| Rate for Payer: Healthfirst Commercial |
$36.17
|
| Rate for Payer: Healthfirst Essential Plan |
$81.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.36
|
| Rate for Payer: Healthfirst QHP |
$36.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.13
|
| Rate for Payer: SOMOS Essential |
$27.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.17
|
|
|
PR COMP ASSES CARE PLAN CCM SVC
|
Professional
|
Both
|
$178.57
|
|
|
Service Code
|
HCPCS G0506
|
| Min. Negotiated Rate |
$33.19 |
| Max. Negotiated Rate |
$106.69 |
| Rate for Payer: Cash Price |
$49.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.56
|
| Rate for Payer: Healthfirst Commercial |
$47.42
|
| Rate for Payer: Healthfirst Essential Plan |
$106.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.05
|
| Rate for Payer: Healthfirst QHP |
$47.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.56
|
| Rate for Payer: SOMOS Essential |
$35.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.42
|
|
|
PR COMPLETE REPLACEMENT PICC RS&I
|
Professional
|
Both
|
$240.63
|
|
|
Service Code
|
HCPCS 36584
|
| Min. Negotiated Rate |
$45.70 |
| Max. Negotiated Rate |
$146.90 |
| Rate for Payer: Cash Price |
$64.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.97
|
| Rate for Payer: Healthfirst Commercial |
$65.29
|
| Rate for Payer: Healthfirst Essential Plan |
$146.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.03
|
| Rate for Payer: Healthfirst QHP |
$65.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.97
|
| Rate for Payer: SOMOS Essential |
$48.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.29
|
|
|
PR COMPLETE RPR ANOMALOUS PULMONARY VENOUS RETURN
|
Professional
|
Both
|
$8,925.32
|
|
|
Service Code
|
HCPCS 33730
|
| Min. Negotiated Rate |
$1,643.63 |
| Max. Negotiated Rate |
$5,283.09 |
| Rate for Payer: Cash Price |
$2,372.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,348.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,113.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,113.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,230.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,348.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,230.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,348.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,348.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,761.03
|
| Rate for Payer: Healthfirst Commercial |
$2,348.04
|
| Rate for Payer: Healthfirst Essential Plan |
$5,283.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,230.64
|
| Rate for Payer: Healthfirst QHP |
$2,348.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,643.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,348.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,995.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,643.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,348.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,761.03
|
| Rate for Payer: SOMOS Essential |
$1,761.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,348.04
|
|
|
PR COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Professional
|
Both
|
$933.66
|
|
|
Service Code
|
HCPCS 93303
|
| Min. Negotiated Rate |
$172.40 |
| Max. Negotiated Rate |
$554.15 |
| Rate for Payer: Amida Care Medicaid |
$178.03
|
| Rate for Payer: Cash Price |
$254.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$221.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$233.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$233.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$246.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$184.72
|
| Rate for Payer: Healthfirst Commercial |
$246.29
|
| Rate for Payer: Healthfirst Essential Plan |
$554.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$233.98
|
| Rate for Payer: Healthfirst QHP |
$246.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$172.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$246.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$209.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$172.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$184.72
|
| Rate for Payer: SOMOS Essential |
$184.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.29
|
|
|
PR COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Professional
|
Both
|
$693.77
|
|
|
Service Code
|
HCPCS 93303 TC
|
| Min. Negotiated Rate |
$126.83 |
| Max. Negotiated Rate |
$407.65 |
| Rate for Payer: Amida Care Medicaid |
$178.03
|
| Rate for Payer: Cash Price |
$188.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$181.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$181.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.88
|
| Rate for Payer: Healthfirst Commercial |
$181.18
|
| Rate for Payer: Healthfirst Essential Plan |
$407.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.12
|
| Rate for Payer: Healthfirst QHP |
$181.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$181.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$181.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.88
|
| Rate for Payer: SOMOS Essential |
$135.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.18
|
|
|
PR COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Professional
|
Both
|
$239.89
|
|
|
Service Code
|
HCPCS 93303 26
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$178.03 |
| Rate for Payer: Amida Care Medicaid |
$178.03
|
| Rate for Payer: Cash Price |
$65.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.83
|
| Rate for Payer: Healthfirst Commercial |
$65.11
|
| Rate for Payer: Healthfirst Essential Plan |
$146.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.85
|
| Rate for Payer: Healthfirst QHP |
$65.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.83
|
| Rate for Payer: SOMOS Essential |
$48.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.11
|
|
|
PR COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
Both
|
$367.36
|
|
|
Service Code
|
HCPCS 99487
|
| Min. Negotiated Rate |
$69.65 |
| Max. Negotiated Rate |
$223.88 |
| Rate for Payer: Cash Price |
$100.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$99.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.62
|
| Rate for Payer: Healthfirst Commercial |
$99.50
|
| Rate for Payer: Healthfirst Essential Plan |
$223.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.53
|
| Rate for Payer: Healthfirst QHP |
$99.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.62
|
| Rate for Payer: SOMOS Essential |
$74.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.50
|
|
|
PR COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Professional
|
Both
|
$1,132.46
|
|
|
Service Code
|
HCPCS 51727 TC
|
| Min. Negotiated Rate |
$192.70 |
| Max. Negotiated Rate |
$619.38 |
| Rate for Payer: Cash Price |
$308.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$275.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$247.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$247.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$261.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$275.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$261.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$206.46
|
| Rate for Payer: Healthfirst Commercial |
$275.28
|
| Rate for Payer: Healthfirst Essential Plan |
$619.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$261.52
|
| Rate for Payer: Healthfirst QHP |
$275.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$192.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$275.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$233.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$192.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$275.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$206.46
|
| Rate for Payer: SOMOS Essential |
$206.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$275.28
|
|
|
PR COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Professional
|
Both
|
$436.59
|
|
|
Service Code
|
HCPCS 51727 26
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$264.01 |
| Rate for Payer: Cash Price |
$119.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.00
|
| Rate for Payer: Healthfirst Commercial |
$117.34
|
| Rate for Payer: Healthfirst Essential Plan |
$264.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.47
|
| Rate for Payer: Healthfirst QHP |
$117.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.00
|
| Rate for Payer: SOMOS Essential |
$88.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.34
|
|
|
PR COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Professional
|
Both
|
$1,569.05
|
|
|
Service Code
|
HCPCS 51727
|
| Min. Negotiated Rate |
$274.83 |
| Max. Negotiated Rate |
$883.39 |
| Rate for Payer: Cash Price |
$427.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$392.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$353.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$372.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$392.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$372.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$392.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$392.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$294.46
|
| Rate for Payer: Healthfirst Commercial |
$392.62
|
| Rate for Payer: Healthfirst Essential Plan |
$883.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$372.99
|
| Rate for Payer: Healthfirst QHP |
$392.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$274.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$392.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$333.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$274.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$392.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$294.46
|
| Rate for Payer: SOMOS Essential |
$294.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$392.62
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$422.63
|
|
|
Service Code
|
HCPCS 51728 26
|
| Min. Negotiated Rate |
$79.59 |
| Max. Negotiated Rate |
$255.82 |
| Rate for Payer: Cash Price |
$114.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.28
|
| Rate for Payer: Healthfirst Commercial |
$113.70
|
| Rate for Payer: Healthfirst Essential Plan |
$255.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.02
|
| Rate for Payer: Healthfirst QHP |
$113.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.28
|
| Rate for Payer: SOMOS Essential |
$85.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.70
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$1,560.86
|
|
|
Service Code
|
HCPCS 51728
|
| Min. Negotiated Rate |
$272.82 |
| Max. Negotiated Rate |
$876.94 |
| Rate for Payer: Cash Price |
$424.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$389.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$350.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$350.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$370.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$389.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$370.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$389.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$389.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$292.31
|
| Rate for Payer: Healthfirst Commercial |
$389.75
|
| Rate for Payer: Healthfirst Essential Plan |
$876.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$370.26
|
| Rate for Payer: Healthfirst QHP |
$389.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$272.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$389.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$331.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$272.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$389.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$292.31
|
| Rate for Payer: SOMOS Essential |
$292.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$389.75
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$1,138.24
|
|
|
Service Code
|
HCPCS 51728 TC
|
| Min. Negotiated Rate |
$193.24 |
| Max. Negotiated Rate |
$621.11 |
| Rate for Payer: Cash Price |
$309.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$276.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$248.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$248.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$262.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$276.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$262.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$276.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$276.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$207.04
|
| Rate for Payer: Healthfirst Commercial |
$276.05
|
| Rate for Payer: Healthfirst Essential Plan |
$621.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$262.25
|
| Rate for Payer: Healthfirst QHP |
$276.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$193.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$276.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$234.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$193.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$276.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$207.04
|
| Rate for Payer: SOMOS Essential |
$207.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$276.05
|
|
|
PR COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$35.39
|
|
|
Service Code
|
HCPCS 51741 26
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Cash Price |
$9.54
|
| 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 COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$25.73
|
|
|
Service Code
|
HCPCS 51741 TC
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Cash Price |
$7.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.42
|
| Rate for Payer: Healthfirst Commercial |
$7.22
|
| Rate for Payer: Healthfirst Essential Plan |
$16.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.86
|
| Rate for Payer: Healthfirst QHP |
$7.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.42
|
| Rate for Payer: SOMOS Essential |
$5.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.22
|
|
|
PR COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$61.11
|
|
|
Service Code
|
HCPCS 51741
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$37.44 |
| Rate for Payer: Cash Price |
$16.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.48
|
| Rate for Payer: Healthfirst Commercial |
$16.64
|
| Rate for Payer: Healthfirst Essential Plan |
$37.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.81
|
| Rate for Payer: Healthfirst QHP |
$16.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.48
|
| Rate for Payer: SOMOS Essential |
$12.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.64
|
|
|
PR COMPL OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE
|
Professional
|
Both
|
$553.25
|
|
|
Service Code
|
HCPCS 92018
|
| Min. Negotiated Rate |
$64.11 |
| Max. Negotiated Rate |
$346.70 |
| Rate for Payer: Amida Care Medicaid |
$64.11
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.57
|
| Rate for Payer: Healthfirst Commercial |
$154.09
|
| Rate for Payer: Healthfirst Essential Plan |
$346.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.39
|
| Rate for Payer: Healthfirst QHP |
$154.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$130.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.57
|
| Rate for Payer: SOMOS Essential |
$115.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.09
|
|
|
PR COMPL RPR TETRALOGY FALLOT W/O PULM ATRESIA
|
Professional
|
Both
|
$8,692.25
|
|
|
Service Code
|
HCPCS 33692
|
| Min. Negotiated Rate |
$1,596.32 |
| Max. Negotiated Rate |
$5,131.03 |
| Rate for Payer: Cash Price |
$2,306.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,280.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,052.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,052.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,166.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,280.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,166.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,280.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,280.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,710.35
|
| Rate for Payer: Healthfirst Commercial |
$2,280.46
|
| Rate for Payer: Healthfirst Essential Plan |
$5,131.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,166.44
|
| Rate for Payer: Healthfirst QHP |
$2,280.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,596.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,280.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,938.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,596.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,280.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,710.35
|
| Rate for Payer: SOMOS Essential |
$1,710.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,280.46
|
|
|
PR COMPL RPR T-FALLOT W/O PULM ATRESIA TANULR PATCH
|
Professional
|
Both
|
$8,673.18
|
|
|
Service Code
|
HCPCS 33694
|
| Min. Negotiated Rate |
$1,594.59 |
| Max. Negotiated Rate |
$5,125.48 |
| Rate for Payer: Cash Price |
$2,303.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,277.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,050.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,050.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,164.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,277.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,164.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,277.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,277.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,708.49
|
| Rate for Payer: Healthfirst Commercial |
$2,277.99
|
| Rate for Payer: Healthfirst Essential Plan |
$5,125.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,164.09
|
| Rate for Payer: Healthfirst QHP |
$2,277.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,594.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,277.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,936.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,594.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,277.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,708.49
|
| Rate for Payer: SOMOS Essential |
$1,708.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,277.99
|
|
