|
PR DUP-SCAN ARTL INFL&VEN O/F PEN VSL COMPL
|
Professional
|
Both
|
$480.73
|
|
|
Service Code
|
HCPCS 93980
|
| Min. Negotiated Rate |
$92.08 |
| Max. Negotiated Rate |
$295.99 |
| Rate for Payer: Amida Care Medicaid |
$142.28
|
| Rate for Payer: Cash Price |
$133.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.66
|
| Rate for Payer: Healthfirst Commercial |
$131.55
|
| Rate for Payer: Healthfirst Essential Plan |
$295.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.97
|
| Rate for Payer: Healthfirst QHP |
$131.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.66
|
| Rate for Payer: SOMOS Essential |
$98.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.55
|
|
|
PR DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD
|
Professional
|
Both
|
$87.61
|
|
|
Service Code
|
HCPCS 93981 26
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$109.64 |
| Rate for Payer: Amida Care Medicaid |
$109.64
|
| Rate for Payer: Cash Price |
$23.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.41
|
| Rate for Payer: Healthfirst Commercial |
$23.22
|
| Rate for Payer: Healthfirst Essential Plan |
$52.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.06
|
| Rate for Payer: Healthfirst QHP |
$23.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.41
|
| Rate for Payer: SOMOS Essential |
$17.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.22
|
|
|
PR DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD
|
Professional
|
Both
|
$212.63
|
|
|
Service Code
|
HCPCS 93981 TC
|
| Min. Negotiated Rate |
$40.38 |
| Max. Negotiated Rate |
$129.78 |
| Rate for Payer: Amida Care Medicaid |
$109.64
|
| Rate for Payer: Cash Price |
$59.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.26
|
| Rate for Payer: Healthfirst Commercial |
$57.68
|
| Rate for Payer: Healthfirst Essential Plan |
$129.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.80
|
| Rate for Payer: Healthfirst QHP |
$57.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.26
|
| Rate for Payer: SOMOS Essential |
$43.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.68
|
|
|
PR DUP-SCAN ARTL INFL&VEN O/F PEN VSL F-UP/LMTD STD
|
Professional
|
Both
|
$300.23
|
|
|
Service Code
|
HCPCS 93981
|
| Min. Negotiated Rate |
$56.63 |
| Max. Negotiated Rate |
$182.03 |
| Rate for Payer: Amida Care Medicaid |
$109.64
|
| Rate for Payer: Cash Price |
$82.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.67
|
| Rate for Payer: Healthfirst Commercial |
$80.90
|
| Rate for Payer: Healthfirst Essential Plan |
$182.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.86
|
| Rate for Payer: Healthfirst QHP |
$80.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.67
|
| Rate for Payer: SOMOS Essential |
$60.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.90
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$1,033.17
|
|
|
Service Code
|
HCPCS 93925
|
| Min. Negotiated Rate |
$144.82 |
| Max. Negotiated Rate |
$615.64 |
| Rate for Payer: Amida Care Medicaid |
$144.82
|
| Rate for Payer: Cash Price |
$282.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$273.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$246.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$246.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$259.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$259.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.22
|
| Rate for Payer: Healthfirst Commercial |
$273.62
|
| Rate for Payer: Healthfirst Essential Plan |
$615.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$259.94
|
| Rate for Payer: Healthfirst QHP |
$273.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$273.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$232.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$273.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$205.22
|
| Rate for Payer: SOMOS Essential |
$205.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$273.62
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$151.13
|
|
|
Service Code
|
HCPCS 93925 26
|
| Min. Negotiated Rate |
$28.41 |
| Max. Negotiated Rate |
$144.82 |
| Rate for Payer: Amida Care Medicaid |
$144.82
|
| Rate for Payer: Cash Price |
$41.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.43
|
| Rate for Payer: Healthfirst Commercial |
$40.58
|
| Rate for Payer: Healthfirst Essential Plan |
$91.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.55
|
| Rate for Payer: Healthfirst QHP |
$40.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$40.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.43
|
| Rate for Payer: SOMOS Essential |
$30.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.58
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$882.07
|
|
|
Service Code
|
HCPCS 93925 TC
|
| Min. Negotiated Rate |
$144.82 |
| Max. Negotiated Rate |
$524.34 |
| Rate for Payer: Amida Care Medicaid |
$144.82
|
| Rate for Payer: Cash Price |
$240.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$233.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$209.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$221.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$233.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$221.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.78
|
| Rate for Payer: Healthfirst Commercial |
$233.04
|
| Rate for Payer: Healthfirst Essential Plan |
$524.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$221.39
|
| Rate for Payer: Healthfirst QHP |
$233.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$163.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$233.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$198.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$163.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$233.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$174.78
|
| Rate for Payer: SOMOS Essential |
$174.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$233.04
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$456.86
|
|
|
Service Code
|
HCPCS 93926 TC
|
| Min. Negotiated Rate |
$92.79 |
| Max. Negotiated Rate |
$314.21 |
| Rate for Payer: Amida Care Medicaid |
$92.79
|
| Rate for Payer: Cash Price |
$143.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$139.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$132.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$139.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$132.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.74
|
| Rate for Payer: Healthfirst Commercial |
$139.65
|
| Rate for Payer: Healthfirst Essential Plan |
$314.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$132.67
|
| Rate for Payer: Healthfirst QHP |
$139.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$139.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$118.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$139.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$104.74
|
| Rate for Payer: SOMOS Essential |
$104.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$139.65
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$92.26
|
|
|
Service Code
|
HCPCS 93926 26
|
| Min. Negotiated Rate |
$17.32 |
| Max. Negotiated Rate |
$92.79 |
| Rate for Payer: Amida Care Medicaid |
$92.79
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.55
|
| Rate for Payer: Healthfirst Commercial |
$24.74
|
| Rate for Payer: Healthfirst Essential Plan |
$55.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.50
|
| Rate for Payer: Healthfirst QHP |
$24.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.55
|
| Rate for Payer: SOMOS Essential |
$18.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.74
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$549.12
|
|
|
Service Code
|
HCPCS 93926
|
| Min. Negotiated Rate |
$92.79 |
| Max. Negotiated Rate |
$369.88 |
| Rate for Payer: Amida Care Medicaid |
$92.79
|
| Rate for Payer: Cash Price |
$169.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$164.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$156.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$164.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$156.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.29
|
| Rate for Payer: Healthfirst Commercial |
$164.39
|
| Rate for Payer: Healthfirst Essential Plan |
$369.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.17
|
| Rate for Payer: Healthfirst QHP |
$164.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$164.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$139.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$164.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.29
|
| Rate for Payer: SOMOS Essential |
$123.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.39
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$844.59
|
|
|
Service Code
|
HCPCS 93930
|
| Min. Negotiated Rate |
$140.49 |
| Max. Negotiated Rate |
$513.11 |
| Rate for Payer: Amida Care Medicaid |
$140.49
|
| Rate for Payer: Cash Price |
$232.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$228.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$205.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$228.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.04
|
| Rate for Payer: Healthfirst Commercial |
$228.05
|
| Rate for Payer: Healthfirst Essential Plan |
$513.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.65
|
| Rate for Payer: Healthfirst QHP |
$228.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$228.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$228.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$171.04
|
| Rate for Payer: SOMOS Essential |
$171.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$228.05
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$688.00
|
|
|
Service Code
|
HCPCS 93930 TC
|
| Min. Negotiated Rate |
$130.52 |
| Max. Negotiated Rate |
$419.54 |
| Rate for Payer: Amida Care Medicaid |
$140.49
|
| Rate for Payer: Cash Price |
$190.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$186.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$177.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$186.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$177.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$186.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$186.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.84
|
| Rate for Payer: Healthfirst Commercial |
$186.46
|
| Rate for Payer: Healthfirst Essential Plan |
$419.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$177.14
|
| Rate for Payer: Healthfirst QHP |
$186.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$130.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$186.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$158.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$130.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$186.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.84
|
| Rate for Payer: SOMOS Essential |
$139.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$186.46
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$156.59
|
|
|
Service Code
|
HCPCS 93930 26
|
| Min. Negotiated Rate |
$29.11 |
| Max. Negotiated Rate |
$140.49 |
| Rate for Payer: Amida Care Medicaid |
$140.49
|
| Rate for Payer: Cash Price |
$42.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.19
|
| Rate for Payer: Healthfirst Commercial |
$41.59
|
| Rate for Payer: Healthfirst Essential Plan |
$93.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.51
|
| Rate for Payer: Healthfirst QHP |
$41.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.19
|
| Rate for Payer: SOMOS Essential |
$31.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.59
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$530.43
|
|
|
Service Code
|
HCPCS 93931
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$317.83 |
| Rate for Payer: Amida Care Medicaid |
$89.76
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.94
|
| Rate for Payer: Healthfirst Commercial |
$141.26
|
| Rate for Payer: Healthfirst Essential Plan |
$317.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.20
|
| Rate for Payer: Healthfirst QHP |
$141.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$120.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.94
|
| Rate for Payer: SOMOS Essential |
$105.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.26
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$93.70
|
|
|
Service Code
|
HCPCS 93931 26
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$89.76 |
| Rate for Payer: Amida Care Medicaid |
$89.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.85
|
| Rate for Payer: Healthfirst Commercial |
$25.13
|
| Rate for Payer: Healthfirst Essential Plan |
$56.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.87
|
| Rate for Payer: Healthfirst QHP |
$25.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.85
|
| Rate for Payer: SOMOS Essential |
$18.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.13
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$436.73
|
|
|
Service Code
|
HCPCS 93931 TC
|
| Min. Negotiated Rate |
$81.29 |
| Max. Negotiated Rate |
$261.29 |
| Rate for Payer: Amida Care Medicaid |
$89.76
|
| Rate for Payer: Cash Price |
$119.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.10
|
| Rate for Payer: Healthfirst Commercial |
$116.13
|
| Rate for Payer: Healthfirst Essential Plan |
$261.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.32
|
| Rate for Payer: Healthfirst QHP |
$116.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.10
|
| Rate for Payer: SOMOS Essential |
$87.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.13
|
|
|
PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Professional
|
Both
|
$676.52
|
|
|
Service Code
|
HCPCS 93970 TC
|
| Min. Negotiated Rate |
$124.66 |
| Max. Negotiated Rate |
$400.68 |
| Rate for Payer: Amida Care Medicaid |
$149.03
|
| Rate for Payer: Cash Price |
$183.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$178.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$160.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$169.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$178.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$169.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.56
|
| Rate for Payer: Healthfirst Commercial |
$178.08
|
| Rate for Payer: Healthfirst Essential Plan |
$400.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$169.18
|
| Rate for Payer: Healthfirst QHP |
$178.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$124.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$178.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$151.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$124.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$178.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$133.56
|
| Rate for Payer: SOMOS Essential |
$133.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$178.08
|
|
|
PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Professional
|
Both
|
$135.73
|
|
|
Service Code
|
HCPCS 93970 26
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$149.03 |
| Rate for Payer: Amida Care Medicaid |
$149.03
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.52
|
| Rate for Payer: Healthfirst Commercial |
$35.36
|
| Rate for Payer: Healthfirst Essential Plan |
$79.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.59
|
| Rate for Payer: Healthfirst QHP |
$35.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.52
|
| Rate for Payer: SOMOS Essential |
$26.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.36
|
|
|
PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Professional
|
Both
|
$812.21
|
|
|
Service Code
|
HCPCS 93970
|
| Min. Negotiated Rate |
$149.03 |
| Max. Negotiated Rate |
$480.22 |
| Rate for Payer: Amida Care Medicaid |
$149.03
|
| Rate for Payer: Cash Price |
$219.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$213.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$192.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.07
|
| Rate for Payer: Healthfirst Commercial |
$213.43
|
| Rate for Payer: Healthfirst Essential Plan |
$480.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.76
|
| Rate for Payer: Healthfirst QHP |
$213.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$213.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$160.07
|
| Rate for Payer: SOMOS Essential |
$160.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.43
|
|
|
PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$87.43
|
|
|
Service Code
|
HCPCS 93971 26
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$95.06 |
| Rate for Payer: Amida Care Medicaid |
$95.06
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.09
|
| Rate for Payer: Healthfirst Commercial |
$22.79
|
| Rate for Payer: Healthfirst Essential Plan |
$51.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.65
|
| Rate for Payer: Healthfirst QHP |
$22.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.09
|
| Rate for Payer: SOMOS Essential |
$17.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.79
|
|
|
PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$426.65
|
|
|
Service Code
|
HCPCS 93971 TC
|
| Min. Negotiated Rate |
$79.66 |
| Max. Negotiated Rate |
$256.05 |
| Rate for Payer: Amida Care Medicaid |
$95.06
|
| Rate for Payer: Cash Price |
$116.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.35
|
| Rate for Payer: Healthfirst Commercial |
$113.80
|
| Rate for Payer: Healthfirst Essential Plan |
$256.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.11
|
| Rate for Payer: Healthfirst QHP |
$113.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.35
|
| Rate for Payer: SOMOS Essential |
$85.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.80
|
|
|
PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$514.08
|
|
|
Service Code
|
HCPCS 93971
|
| Min. Negotiated Rate |
$95.06 |
| Max. Negotiated Rate |
$307.33 |
| Rate for Payer: Amida Care Medicaid |
$95.06
|
| Rate for Payer: Cash Price |
$139.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.44
|
| Rate for Payer: Healthfirst Commercial |
$136.59
|
| Rate for Payer: Healthfirst Essential Plan |
$307.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.76
|
| Rate for Payer: Healthfirst QHP |
$136.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.44
|
| Rate for Payer: SOMOS Essential |
$102.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.59
|
|
|
PR DURAL GRAFT SPINAL
|
Professional
|
Both
|
$4,956.04
|
|
|
Service Code
|
HCPCS 63710
|
| Min. Negotiated Rate |
$928.14 |
| Max. Negotiated Rate |
$2,983.32 |
| Rate for Payer: Cash Price |
$1,331.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,325.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,193.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,193.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,259.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,325.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,259.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,325.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,325.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$994.44
|
| Rate for Payer: Healthfirst Commercial |
$1,325.92
|
| Rate for Payer: Healthfirst Essential Plan |
$2,983.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,259.62
|
| Rate for Payer: Healthfirst QHP |
$1,325.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$928.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,325.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,127.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$928.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,325.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$994.44
|
| Rate for Payer: SOMOS Essential |
$994.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,325.92
|
|
|
PR DX DARK ADAPTATION EXAM INTERPRETATION & REPORT
|
Professional
|
Both
|
$199.68
|
|
|
Service Code
|
HCPCS 92284
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$79.99 |
| Rate for Payer: Cash Price |
$44.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.66
|
| Rate for Payer: Healthfirst Commercial |
$35.55
|
| Rate for Payer: Healthfirst Essential Plan |
$79.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.77
|
| Rate for Payer: Healthfirst QHP |
$35.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.66
|
| Rate for Payer: SOMOS Essential |
$26.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.55
|
|
|
PR DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS
|
Professional
|
Both
|
$483.46
|
|
|
Service Code
|
HCPCS 54231
|
| Min. Negotiated Rate |
$92.18 |
| Max. Negotiated Rate |
$296.30 |
| Rate for Payer: Cash Price |
$132.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.77
|
| Rate for Payer: Healthfirst Commercial |
$131.69
|
| Rate for Payer: Healthfirst Essential Plan |
$296.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.11
|
| Rate for Payer: Healthfirst QHP |
$131.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.77
|
| Rate for Payer: SOMOS Essential |
$98.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.69
|
|
