|
PR COMPL RPR T-FALLOT W/PULM ATRESIA
|
Professional
|
Both
|
$9,136.96
|
|
|
Service Code
|
HCPCS 33697
|
| Min. Negotiated Rate |
$1,680.11 |
| Max. Negotiated Rate |
$5,400.34 |
| Rate for Payer: Cash Price |
$2,426.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,400.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,160.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,160.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,280.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,400.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,280.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,400.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,400.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,800.11
|
| Rate for Payer: Healthfirst Commercial |
$2,400.15
|
| Rate for Payer: Healthfirst Essential Plan |
$5,400.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,280.14
|
| Rate for Payer: Healthfirst QHP |
$2,400.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,680.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,400.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,040.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,680.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,400.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,800.11
|
| Rate for Payer: SOMOS Essential |
$1,800.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,400.15
|
|
|
PR COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$1,136.77
|
|
|
Service Code
|
HCPCS 51729 TC
|
| Min. Negotiated Rate |
$191.50 |
| Max. Negotiated Rate |
$615.53 |
| Rate for Payer: Cash Price |
$307.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$273.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$246.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$246.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$259.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$259.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.18
|
| Rate for Payer: Healthfirst Commercial |
$273.57
|
| Rate for Payer: Healthfirst Essential Plan |
$615.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$259.89
|
| Rate for Payer: Healthfirst QHP |
$273.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$273.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$232.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$273.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$205.18
|
| Rate for Payer: SOMOS Essential |
$205.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$273.57
|
|
|
PR COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$517.76
|
|
|
Service Code
|
HCPCS 51729 26
|
| Min. Negotiated Rate |
$98.18 |
| Max. Negotiated Rate |
$315.58 |
| Rate for Payer: Cash Price |
$140.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.19
|
| Rate for Payer: Healthfirst Commercial |
$140.26
|
| Rate for Payer: Healthfirst Essential Plan |
$315.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.25
|
| Rate for Payer: Healthfirst QHP |
$140.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.19
|
| Rate for Payer: SOMOS Essential |
$105.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.26
|
|
|
PR COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$1,654.56
|
|
|
Service Code
|
HCPCS 51729
|
| Min. Negotiated Rate |
$289.68 |
| Max. Negotiated Rate |
$931.12 |
| Rate for Payer: Cash Price |
$447.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$413.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$372.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$372.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$393.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$413.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$393.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$413.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$413.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$310.37
|
| Rate for Payer: Healthfirst Commercial |
$413.83
|
| Rate for Payer: Healthfirst Essential Plan |
$931.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$393.14
|
| Rate for Payer: Healthfirst QHP |
$413.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$289.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$413.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$351.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$289.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$413.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$310.37
|
| Rate for Payer: SOMOS Essential |
$310.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$413.83
|
|
|
PR COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$20,401.40
|
|
|
Service Code
|
HCPCS 61697
|
| Min. Negotiated Rate |
$3,704.55 |
| Max. Negotiated Rate |
$11,907.50 |
| Rate for Payer: Cash Price |
$5,354.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,292.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,763.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,763.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,027.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,292.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,027.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,292.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,292.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,969.16
|
| Rate for Payer: Healthfirst Commercial |
$5,292.22
|
| Rate for Payer: Healthfirst Essential Plan |
$11,907.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,027.61
|
| Rate for Payer: Healthfirst QHP |
$5,292.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,704.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,292.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4,498.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,704.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,292.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,969.16
|
| Rate for Payer: SOMOS Essential |
$3,969.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,292.22
|
|
|
PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ
|
Professional
|
Both
|
$126.63
|
|
|
Service Code
|
HCPCS 92557
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$78.10 |
| Rate for Payer: Amida Care Medicaid |
$26.91
|
| Rate for Payer: Cash Price |
$34.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.03
|
| Rate for Payer: Healthfirst Commercial |
$34.71
|
| Rate for Payer: Healthfirst Essential Plan |
$78.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.97
|
| Rate for Payer: Healthfirst QHP |
$34.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.03
|
| Rate for Payer: SOMOS Essential |
$26.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.71
|
|
|
PR COMPRE CPTR MTN ALYS VIDEO TAPING 3D KINEMATICS
|
Professional
|
Both
|
$328.13
|
|
|
Service Code
|
HCPCS 96000
|
| Min. Negotiated Rate |
$62.85 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Cash Price |
$90.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.33
|
| Rate for Payer: Healthfirst Commercial |
$89.78
|
| Rate for Payer: Healthfirst Essential Plan |
$202.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.29
|
| Rate for Payer: Healthfirst QHP |
$89.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.33
|
| Rate for Payer: SOMOS Essential |
$67.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.78
|
|
|
PR COMPRE CPTR MTN ALYS W/DYN PLNTR PRES MEAS WALKG
|
Professional
|
Both
|
$450.91
|
|
|
Service Code
|
HCPCS 96001
|
| Min. Negotiated Rate |
$81.98 |
| Max. Negotiated Rate |
$263.50 |
| Rate for Payer: Cash Price |
$122.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.83
|
| Rate for Payer: Healthfirst Commercial |
$117.11
|
| Rate for Payer: Healthfirst Essential Plan |
$263.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.25
|
| Rate for Payer: Healthfirst QHP |
$117.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.83
|
| Rate for Payer: SOMOS Essential |
$87.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.11
|
|
|
PR COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION
|
Professional
|
Both
|
$2,673.93
|
|
|
Service Code
|
HCPCS 93620 26
|
| Min. Negotiated Rate |
$489.04 |
| Max. Negotiated Rate |
$1,571.92 |
| Rate for Payer: Amida Care Medicaid |
$789.74
|
| Rate for Payer: Cash Price |
$706.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$698.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$628.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$628.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$663.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$698.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$663.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$698.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$698.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$523.97
|
| Rate for Payer: Healthfirst Commercial |
$698.63
|
| Rate for Payer: Healthfirst Essential Plan |
$1,571.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$663.70
|
| Rate for Payer: Healthfirst QHP |
$698.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$489.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$698.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$593.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$489.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$698.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$523.97
|
| Rate for Payer: SOMOS Essential |
$523.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$698.63
|
|
|
PR COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION
|
Professional
|
Both
|
$1,688.16
|
|
|
Service Code
|
HCPCS 93620 TC
|
| Min. Negotiated Rate |
$789.74 |
| Max. Negotiated Rate |
$789.74 |
| Rate for Payer: Amida Care Medicaid |
$789.74
|
|
|
PR COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION
|
Professional
|
Both
|
$4,362.09
|
|
|
Service Code
|
HCPCS 93620
|
| Min. Negotiated Rate |
$789.74 |
| Max. Negotiated Rate |
$789.74 |
| Rate for Payer: Amida Care Medicaid |
$789.74
|
|
|
PR COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION
|
Professional
|
Both
|
$1,658.55
|
|
|
Service Code
|
HCPCS 93619 26
|
| Min. Negotiated Rate |
$302.96 |
| Max. Negotiated Rate |
$973.80 |
| Rate for Payer: Amida Care Medicaid |
$568.75
|
| Rate for Payer: Cash Price |
$439.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$432.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$389.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$389.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$411.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$432.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$411.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$432.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$324.60
|
| Rate for Payer: Healthfirst Commercial |
$432.80
|
| Rate for Payer: Healthfirst Essential Plan |
$973.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$411.16
|
| Rate for Payer: Healthfirst QHP |
$432.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$302.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$432.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$367.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$302.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$432.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: SOMOS Essential |
$324.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$432.80
|
|
|
PR COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION
|
Professional
|
Both
|
$3,231.52
|
|
|
Service Code
|
HCPCS 93619
|
| Min. Negotiated Rate |
$568.75 |
| Max. Negotiated Rate |
$568.75 |
| Rate for Payer: Amida Care Medicaid |
$568.75
|
|
|
PR COMPRE ELECTROPHYSIOLOGIC W/O ARRHYT INDUCTION
|
Professional
|
Both
|
$1,572.97
|
|
|
Service Code
|
HCPCS 93619 TC
|
| Min. Negotiated Rate |
$568.75 |
| Max. Negotiated Rate |
$568.75 |
| Rate for Payer: Amida Care Medicaid |
$568.75
|
|
|
PR COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC
|
Professional
|
Both
|
$8,067.89
|
|
|
Service Code
|
HCPCS 93621 TC
|
| Min. Negotiated Rate |
$1,687.25 |
| Max. Negotiated Rate |
$1,687.25 |
| Rate for Payer: Amida Care Medicaid |
$1,687.25
|
|
|
PR COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC
|
Professional
|
Both
|
$8,421.63
|
|
|
Service Code
|
HCPCS 93621
|
| Min. Negotiated Rate |
$1,687.25 |
| Max. Negotiated Rate |
$1,687.25 |
| Rate for Payer: Amida Care Medicaid |
$1,687.25
|
|
|
PR COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC
|
Professional
|
Both
|
$353.75
|
|
|
Service Code
|
HCPCS 93621 26
|
| Min. Negotiated Rate |
$64.86 |
| Max. Negotiated Rate |
$1,687.25 |
| Rate for Payer: Amida Care Medicaid |
$1,687.25
|
| Rate for Payer: Cash Price |
$94.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.50
|
| Rate for Payer: Healthfirst Commercial |
$92.66
|
| Rate for Payer: Healthfirst Essential Plan |
$208.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.03
|
| Rate for Payer: Healthfirst QHP |
$92.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.50
|
| Rate for Payer: SOMOS Essential |
$69.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.66
|
|
|
PR COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC
|
Professional
|
Both
|
$8,933.89
|
|
|
Service Code
|
HCPCS 93622
|
| Min. Negotiated Rate |
$1,759.64 |
| Max. Negotiated Rate |
$1,759.64 |
| Rate for Payer: Amida Care Medicaid |
$1,759.64
|
|
|
PR COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC
|
Professional
|
Both
|
$8,200.05
|
|
|
Service Code
|
HCPCS 93622 TC
|
| Min. Negotiated Rate |
$1,759.64 |
| Max. Negotiated Rate |
$1,759.64 |
| Rate for Payer: Amida Care Medicaid |
$1,759.64
|
|
|
PR COMPRE ELECTROPHYSIOL XM W/LEFT VENTR PACNG/REC
|
Professional
|
Both
|
$733.85
|
|
|
Service Code
|
HCPCS 93622 26
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$1,759.64 |
| Rate for Payer: Amida Care Medicaid |
$1,759.64
|
| Rate for Payer: Cash Price |
$193.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$173.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$183.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$183.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.59
|
| Rate for Payer: Healthfirst Commercial |
$192.79
|
| Rate for Payer: Healthfirst Essential Plan |
$433.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$183.15
|
| Rate for Payer: Healthfirst QHP |
$192.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$192.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$163.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.59
|
| Rate for Payer: SOMOS Essential |
$144.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.79
|
|
|
PR COMPRE EP EVAL ABLTJ 3D MAPG TX SVT
|
Professional
|
Both
|
$3,705.56
|
|
|
Service Code
|
HCPCS 93653
|
| Min. Negotiated Rate |
$429.44 |
| Max. Negotiated Rate |
$2,163.76 |
| Rate for Payer: Amida Care Medicaid |
$429.44
|
| Rate for Payer: Cash Price |
$972.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$961.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$865.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$913.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$961.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$913.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$961.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$961.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$721.25
|
| Rate for Payer: Healthfirst Commercial |
$961.67
|
| Rate for Payer: Healthfirst Essential Plan |
$2,163.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$913.59
|
| Rate for Payer: Healthfirst QHP |
$961.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$673.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$961.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$817.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$673.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$961.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$721.25
|
| Rate for Payer: SOMOS Essential |
$721.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$961.67
|
|
|
PR COMPRE EP EVAL ABLTJ 3D MAPG TX VT
|
Professional
|
Both
|
$4,466.63
|
|
|
Service Code
|
HCPCS 93654
|
| Min. Negotiated Rate |
$573.13 |
| Max. Negotiated Rate |
$2,608.45 |
| Rate for Payer: Amida Care Medicaid |
$573.13
|
| Rate for Payer: Cash Price |
$1,171.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,159.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,043.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,043.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,101.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,159.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,101.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,159.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,159.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$869.48
|
| Rate for Payer: Healthfirst Commercial |
$1,159.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,608.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,101.34
|
| Rate for Payer: Healthfirst QHP |
$1,159.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$811.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,159.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$985.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$811.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,159.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$869.48
|
| Rate for Payer: SOMOS Essential |
$869.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,159.31
|
|
|
PR COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION
|
Professional
|
Both
|
$4,202.80
|
|
|
Service Code
|
HCPCS 93656
|
| Min. Negotiated Rate |
$573.30 |
| Max. Negotiated Rate |
$2,451.06 |
| Rate for Payer: Amida Care Medicaid |
$573.30
|
| Rate for Payer: Cash Price |
$1,102.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,089.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$980.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$980.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,034.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,089.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,034.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,089.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,089.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$817.02
|
| Rate for Payer: Healthfirst Commercial |
$1,089.36
|
| Rate for Payer: Healthfirst Essential Plan |
$2,451.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,034.89
|
| Rate for Payer: Healthfirst QHP |
$1,089.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$762.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,089.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$925.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$762.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,089.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$817.02
|
| Rate for Payer: SOMOS Essential |
$817.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,089.36
|
|
|
PR COMPUTER-AIDED MAPG CERVIX UTERI DRG COLPOSCOPY
|
Professional
|
Both
|
$187.18
|
|
|
Service Code
|
HCPCS 57465
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Cash Price |
$49.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.20
|
| Rate for Payer: Healthfirst Commercial |
$49.60
|
| Rate for Payer: Healthfirst Essential Plan |
$111.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.12
|
| Rate for Payer: Healthfirst QHP |
$49.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.20
|
| Rate for Payer: SOMOS Essential |
$37.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.60
|
|
|
PR COMPUTERIZED CORNEAL TOPOGRAPHY UNI/BI W/I&R
|
Professional
|
Both
|
$74.62
|
|
|
Service Code
|
HCPCS 92025 TC
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$45.92 |
| Rate for Payer: Amida Care Medicaid |
$24.87
|
| Rate for Payer: Cash Price |
$20.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.31
|
| Rate for Payer: Healthfirst Commercial |
$20.41
|
| Rate for Payer: Healthfirst Essential Plan |
$45.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.39
|
| Rate for Payer: Healthfirst QHP |
$20.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.31
|
| Rate for Payer: SOMOS Essential |
$15.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.41
|
|
