|
PR CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPTMENT
|
Professional
|
Both
|
$629.06
|
|
|
Service Code
|
HCPCS 95250
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$378.50 |
| Rate for Payer: Amida Care Medicaid |
$84.80
|
| Rate for Payer: Cash Price |
$175.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$168.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$151.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$151.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$168.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$159.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.17
|
| Rate for Payer: Healthfirst Commercial |
$168.22
|
| Rate for Payer: Healthfirst Essential Plan |
$378.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$159.81
|
| Rate for Payer: Healthfirst QHP |
$168.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$117.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$168.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$142.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$117.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$168.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.17
|
| Rate for Payer: SOMOS Essential |
$126.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$168.22
|
|
|
PR CONT GLUC MONITORING PATIENT PROVIDED EQUIPTMENT
|
Professional
|
Both
|
$266.81
|
|
|
Service Code
|
HCPCS 95249
|
| Min. Negotiated Rate |
$54.45 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.34
|
| Rate for Payer: Healthfirst Commercial |
$77.78
|
| Rate for Payer: Healthfirst Essential Plan |
$175.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.89
|
| Rate for Payer: Healthfirst QHP |
$77.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.34
|
| Rate for Payer: SOMOS Essential |
$58.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.78
|
|
|
PR CONTINENT DVRJ W/INT ANAST ANY SGM SM&/LG INTSTN
|
Professional
|
Both
|
$6,855.24
|
|
|
Service Code
|
HCPCS 50825
|
| Min. Negotiated Rate |
$1,301.68 |
| Max. Negotiated Rate |
$4,183.97 |
| Rate for Payer: Cash Price |
$1,870.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,859.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,673.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,673.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,766.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,859.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,766.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,859.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,859.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,394.65
|
| Rate for Payer: Healthfirst Commercial |
$1,859.54
|
| Rate for Payer: Healthfirst Essential Plan |
$4,183.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,766.56
|
| Rate for Payer: Healthfirst QHP |
$1,859.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,301.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,859.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,580.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,301.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,859.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,394.65
|
| Rate for Payer: SOMOS Essential |
$1,394.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,859.54
|
|
|
PR CONTINENT ILEOSTOMY KOCK PROCEDURE SPX
|
Professional
|
Both
|
$6,405.81
|
|
|
Service Code
|
HCPCS 44316
|
| Min. Negotiated Rate |
$1,184.15 |
| Max. Negotiated Rate |
$3,806.19 |
| Rate for Payer: Cash Price |
$1,705.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,691.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,522.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,522.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,607.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,691.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,607.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,691.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,691.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,268.73
|
| Rate for Payer: Healthfirst Commercial |
$1,691.64
|
| Rate for Payer: Healthfirst Essential Plan |
$3,806.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,607.06
|
| Rate for Payer: Healthfirst QHP |
$1,691.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,184.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,691.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,437.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,184.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,691.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,268.73
|
| Rate for Payer: SOMOS Essential |
$1,268.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,691.64
|
|
|
PR CONT INTRAOP NEURO MONITOR
|
Professional
|
Both
|
$129.22
|
|
|
Service Code
|
HCPCS G0453
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$78.28 |
| Rate for Payer: Cash Price |
$35.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.09
|
| Rate for Payer: Healthfirst Commercial |
$34.79
|
| Rate for Payer: Healthfirst Essential Plan |
$78.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.05
|
| Rate for Payer: Healthfirst QHP |
$34.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.09
|
| Rate for Payer: SOMOS Essential |
$26.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.79
|
|
|
PR CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R
|
Professional
|
Both
|
$138.88
|
|
|
Service Code
|
HCPCS 95251
|
| Min. Negotiated Rate |
$19.33 |
| Max. Negotiated Rate |
$85.14 |
| Rate for Payer: Amida Care Medicaid |
$19.33
|
| Rate for Payer: Cash Price |
$38.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.38
|
| Rate for Payer: Healthfirst Commercial |
$37.84
|
| Rate for Payer: Healthfirst Essential Plan |
$85.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.95
|
| Rate for Payer: Healthfirst QHP |
$37.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.38
|
| Rate for Payer: SOMOS Essential |
$28.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.84
|
|
|
PR CONTINUOUS INHALATION TREATMENT 1ST HR
|
Professional
|
Both
|
$257.18
|
|
|
Service Code
|
HCPCS 94644
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$152.12 |
| Rate for Payer: Amida Care Medicaid |
$20.27
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.71
|
| Rate for Payer: Healthfirst Commercial |
$67.61
|
| Rate for Payer: Healthfirst Essential Plan |
$152.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.23
|
| Rate for Payer: Healthfirst QHP |
$67.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.71
|
| Rate for Payer: SOMOS Essential |
$50.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.61
|
|
|
PR CONTINUOUS INHALATION TREATMENT EA ADDL HR
|
Professional
|
Both
|
$68.85
|
|
|
Service Code
|
HCPCS 94645
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$45.07 |
| Rate for Payer: Amida Care Medicaid |
$7.64
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.02
|
| Rate for Payer: Healthfirst Commercial |
$20.03
|
| Rate for Payer: Healthfirst Essential Plan |
$45.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.03
|
| Rate for Payer: Healthfirst QHP |
$20.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.02
|
| Rate for Payer: SOMOS Essential |
$15.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.03
|
|
|
PR CONTINUOUS NEGATIVE PRESSURE VENTJ INITIAT&MGM
|
Professional
|
Both
|
$141.79
|
|
|
Service Code
|
HCPCS 94662
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$84.19 |
| Rate for Payer: Cash Price |
$38.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Healthfirst Commercial |
$37.42
|
| Rate for Payer: Healthfirst Essential Plan |
$84.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.55
|
| Rate for Payer: Healthfirst QHP |
$37.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.07
|
| Rate for Payer: SOMOS Essential |
$28.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.42
|
|
|
PR CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE
|
Professional
|
Both
|
$125.69
|
|
|
Service Code
|
HCPCS 49465
|
| Min. Negotiated Rate |
$23.09 |
| Max. Negotiated Rate |
$74.23 |
| Rate for Payer: Cash Price |
$33.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$32.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.74
|
| Rate for Payer: Healthfirst Commercial |
$32.99
|
| Rate for Payer: Healthfirst Essential Plan |
$74.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31.34
|
| Rate for Payer: Healthfirst QHP |
$32.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$32.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24.74
|
| Rate for Payer: SOMOS Essential |
$24.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.99
|
|
|
PR CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX
|
Professional
|
Both
|
$337.33
|
|
|
Service Code
|
HCPCS 30903
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$201.47 |
| Rate for Payer: Cash Price |
$89.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$85.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$85.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.16
|
| Rate for Payer: Healthfirst Commercial |
$89.54
|
| Rate for Payer: Healthfirst Essential Plan |
$201.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$85.06
|
| Rate for Payer: Healthfirst QHP |
$89.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$76.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.16
|
| Rate for Payer: SOMOS Essential |
$67.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.54
|
|
|
PR CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE
|
Professional
|
Both
|
$247.28
|
|
|
Service Code
|
HCPCS 30901
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$146.09 |
| Rate for Payer: Cash Price |
$65.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.70
|
| Rate for Payer: Healthfirst Commercial |
$64.93
|
| Rate for Payer: Healthfirst Essential Plan |
$146.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.68
|
| Rate for Payer: Healthfirst QHP |
$64.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.70
|
| Rate for Payer: SOMOS Essential |
$48.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.93
|
|
|
PR CONTROL OROPHARYNGEAL HEMORRHAGE SIMPLE
|
Professional
|
Both
|
$687.79
|
|
|
Service Code
|
HCPCS 42960
|
| Min. Negotiated Rate |
$131.50 |
| Max. Negotiated Rate |
$422.66 |
| Rate for Payer: Cash Price |
$189.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$187.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$169.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$169.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$178.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$187.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$178.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.89
|
| Rate for Payer: Healthfirst Commercial |
$187.85
|
| Rate for Payer: Healthfirst Essential Plan |
$422.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$178.46
|
| Rate for Payer: Healthfirst QHP |
$187.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$131.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$187.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$159.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$131.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$187.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.89
|
| Rate for Payer: SOMOS Essential |
$140.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$187.85
|
|
|
PR CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERQ
|
Professional
|
Both
|
$598.89
|
|
|
Service Code
|
HCPCS 49446
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$362.56 |
| Rate for Payer: Cash Price |
$161.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$161.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$145.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$145.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$153.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$161.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$153.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.86
|
| Rate for Payer: Healthfirst Commercial |
$161.14
|
| Rate for Payer: Healthfirst Essential Plan |
$362.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.08
|
| Rate for Payer: Healthfirst QHP |
$161.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$161.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$161.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.86
|
| Rate for Payer: SOMOS Essential |
$120.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.14
|
|
|
PR CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ
|
Professional
|
Both
|
$779.35
|
|
|
Service Code
|
HCPCS 50434
|
| Min. Negotiated Rate |
$147.25 |
| Max. Negotiated Rate |
$473.29 |
| Rate for Payer: Cash Price |
$211.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$210.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$189.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$189.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$210.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.76
|
| Rate for Payer: Healthfirst Commercial |
$210.35
|
| Rate for Payer: Healthfirst Essential Plan |
$473.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.83
|
| Rate for Payer: Healthfirst QHP |
$210.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$147.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$210.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$147.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$210.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$157.76
|
| Rate for Payer: SOMOS Essential |
$157.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$210.35
|
|
|
PR CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH
|
Professional
|
Both
|
$799.68
|
|
|
Service Code
|
HCPCS 47535
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$484.22 |
| Rate for Payer: Cash Price |
$215.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$215.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$193.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$193.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$204.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$215.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$204.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$215.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$215.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.41
|
| Rate for Payer: Healthfirst Commercial |
$215.21
|
| Rate for Payer: Healthfirst Essential Plan |
$484.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$204.45
|
| Rate for Payer: Healthfirst QHP |
$215.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$150.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$215.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$182.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$150.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$215.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$161.41
|
| Rate for Payer: SOMOS Essential |
$161.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$215.21
|
|
|
PR CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT
|
Professional
|
Both
|
$7,362.32
|
|
|
Service Code
|
HCPCS 27132
|
| Min. Negotiated Rate |
$1,379.33 |
| Max. Negotiated Rate |
$4,433.56 |
| Rate for Payer: Cash Price |
$1,980.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,970.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,773.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,773.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,871.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,970.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,871.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,970.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,970.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,477.85
|
| Rate for Payer: Healthfirst Commercial |
$1,970.47
|
| Rate for Payer: Healthfirst Essential Plan |
$4,433.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,871.95
|
| Rate for Payer: Healthfirst QHP |
$1,970.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,379.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,970.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,674.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,379.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,970.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,477.85
|
| Rate for Payer: SOMOS Essential |
$1,477.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,970.47
|
|
|
PR CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY
|
Professional
|
Both
|
$3,099.74
|
|
|
Service Code
|
HCPCS 23415
|
| Min. Negotiated Rate |
$587.21 |
| Max. Negotiated Rate |
$1,887.46 |
| Rate for Payer: Cash Price |
$838.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$838.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$754.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$754.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$796.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$838.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$796.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$838.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$838.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$629.15
|
| Rate for Payer: Healthfirst Commercial |
$838.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,887.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$796.93
|
| Rate for Payer: Healthfirst QHP |
$838.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$587.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$838.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$713.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$587.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$838.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$629.15
|
| Rate for Payer: SOMOS Essential |
$629.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$838.87
|
|
|
PR CORDOCENTESIS INTRAUTERINE
|
Professional
|
Both
|
$934.05
|
|
|
Service Code
|
HCPCS 59012
|
| Min. Negotiated Rate |
$170.07 |
| Max. Negotiated Rate |
$546.66 |
| Rate for Payer: Cash Price |
$247.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$230.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$230.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.22
|
| Rate for Payer: Healthfirst Commercial |
$242.96
|
| Rate for Payer: Healthfirst Essential Plan |
$546.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$230.81
|
| Rate for Payer: Healthfirst QHP |
$242.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$170.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$242.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$206.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$170.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$182.22
|
| Rate for Payer: SOMOS Essential |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.96
|
|
|
PR CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG
|
Professional
|
Both
|
$622.69
|
|
|
Service Code
|
HCPCS 32408
|
| Min. Negotiated Rate |
$116.56 |
| Max. Negotiated Rate |
$374.67 |
| Rate for Payer: Cash Price |
$168.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$166.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$149.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$158.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$166.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$166.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$166.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.89
|
| Rate for Payer: Healthfirst Commercial |
$166.52
|
| Rate for Payer: Healthfirst Essential Plan |
$374.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$158.19
|
| Rate for Payer: Healthfirst QHP |
$166.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$116.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$166.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$141.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$116.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$166.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$124.89
|
| Rate for Payer: SOMOS Essential |
$124.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.52
|
|
|
PR CORF RELATED SERV 15 MINS EA
|
Professional
|
Both
|
$99.05
|
|
|
Service Code
|
HCPCS G0409
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$63.41 |
| Rate for Payer: Cash Price |
$28.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.14
|
| Rate for Payer: Healthfirst Commercial |
$28.18
|
| Rate for Payer: Healthfirst Essential Plan |
$63.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.77
|
| Rate for Payer: Healthfirst QHP |
$28.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.14
|
| Rate for Payer: SOMOS Essential |
$21.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.18
|
|
|
PR CORF SKILLED NURSING SERVICE
|
Professional
|
Both
|
$40.11
|
|
|
Service Code
|
HCPCS G0128
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$25.85 |
| Rate for Payer: Cash Price |
$11.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.62
|
| Rate for Payer: Healthfirst Commercial |
$11.49
|
| Rate for Payer: Healthfirst Essential Plan |
$25.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.92
|
| Rate for Payer: Healthfirst QHP |
$11.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$11.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.62
|
| Rate for Payer: SOMOS Essential |
$8.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.49
|
|
|
PR CORNEA HYSTERESIS DETERMIN IMPULSE STIMJ UNI/BI
|
Professional
|
Both
|
$55.37
|
|
|
Service Code
|
HCPCS 92145
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$34.11 |
| Rate for Payer: Cash Price |
$15.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.37
|
| Rate for Payer: Healthfirst Commercial |
$15.16
|
| Rate for Payer: Healthfirst Essential Plan |
$34.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.40
|
| Rate for Payer: Healthfirst QHP |
$15.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.37
|
| Rate for Payer: SOMOS Essential |
$11.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.16
|
|
|
PR CORNEA HYSTERESIS DETERMIN IMPULSE STIMJ UNI/BI
|
Professional
|
Both
|
$32.94
|
|
|
Service Code
|
HCPCS 92145 TC
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$20.61 |
| Rate for Payer: Cash Price |
$9.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.87
|
| Rate for Payer: Healthfirst Commercial |
$9.16
|
| Rate for Payer: Healthfirst Essential Plan |
$20.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.70
|
| Rate for Payer: Healthfirst QHP |
$9.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.87
|
| Rate for Payer: SOMOS Essential |
$6.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.16
|
|
|
PR CORNEA HYSTERESIS DETERMIN IMPULSE STIMJ UNI/BI
|
Professional
|
Both
|
$22.44
|
|
|
Service Code
|
HCPCS 92145 26
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Cash Price |
$6.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.50
|
| Rate for Payer: Healthfirst Commercial |
$6.00
|
| Rate for Payer: Healthfirst Essential Plan |
$13.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.70
|
| Rate for Payer: Healthfirst QHP |
$6.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$4.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$4.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4.50
|
| Rate for Payer: SOMOS Essential |
$4.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.00
|
|
