|
PR DYN FINE WIRE EMG WALKG/FUNCJAL ACTV 1 MUSC
|
Professional
|
Both
|
$64.89
|
|
|
Service Code
|
HCPCS 96003
|
| Rate for Payer: Cash Price |
$17.85
|
|
|
PR DYN SURF EMG WALKG/FUNCJAL ACTV 1-12 MUSC
|
Professional
|
Both
|
$89.60
|
|
|
Service Code
|
HCPCS 96002
|
| Min. Negotiated Rate |
$16.62 |
| Max. Negotiated Rate |
$53.41 |
| Rate for Payer: Amida Care Medicaid |
$45.45
|
| Rate for Payer: Cash Price |
$23.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.80
|
| Rate for Payer: Healthfirst Commercial |
$23.74
|
| Rate for Payer: Healthfirst Essential Plan |
$53.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.55
|
| Rate for Payer: Healthfirst QHP |
$23.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.80
|
| Rate for Payer: SOMOS Essential |
$17.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.74
|
|
|
PR EAR PROTECTOR ATTENUATION MEASUREMENTS
|
Professional
|
Both
|
$316.12
|
|
|
Service Code
|
HCPCS 92596
|
| Min. Negotiated Rate |
$65.37 |
| Max. Negotiated Rate |
$210.13 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.04
|
| Rate for Payer: Healthfirst Commercial |
$93.39
|
| Rate for Payer: Healthfirst Essential Plan |
$210.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.72
|
| Rate for Payer: Healthfirst QHP |
$93.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.04
|
| Rate for Payer: SOMOS Essential |
$70.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.39
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY
|
Professional
|
Both
|
$32.66
|
|
|
Service Code
|
HCPCS 93010
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$19.80 |
| Rate for Payer: Amida Care Medicaid |
$7.58
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.60
|
| Rate for Payer: Healthfirst Commercial |
$8.80
|
| Rate for Payer: Healthfirst Essential Plan |
$19.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.36
|
| Rate for Payer: Healthfirst QHP |
$8.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.60
|
| Rate for Payer: SOMOS Essential |
$6.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.80
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R
|
Professional
|
Both
|
$28.60
|
|
|
Service Code
|
HCPCS 93005
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.70
|
| Rate for Payer: Healthfirst Commercial |
$7.60
|
| Rate for Payer: Healthfirst Essential Plan |
$17.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.22
|
| Rate for Payer: Healthfirst QHP |
$7.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$7.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.70
|
| Rate for Payer: SOMOS Essential |
$5.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.60
|
|
|
PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R
|
Professional
|
Both
|
$61.25
|
|
|
Service Code
|
HCPCS 93000
|
| Min. Negotiated Rate |
$11.49 |
| Max. Negotiated Rate |
$36.92 |
| Rate for Payer: Amida Care Medicaid |
$15.15
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.31
|
| Rate for Payer: Healthfirst Commercial |
$16.41
|
| Rate for Payer: Healthfirst Essential Plan |
$36.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.59
|
| Rate for Payer: Healthfirst QHP |
$16.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$11.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$16.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$11.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.31
|
| Rate for Payer: SOMOS Essential |
$12.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.41
|
|
|
PR ECHO GUIDANCE RADIOTHERAPY
|
Professional
|
Both
|
$126.98
|
|
|
Service Code
|
HCPCS G6001 26
|
| Min. Negotiated Rate |
$24.36 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Cash Price |
$34.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.10
|
| Rate for Payer: Healthfirst Commercial |
$34.80
|
| Rate for Payer: Healthfirst Essential Plan |
$78.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.06
|
| Rate for Payer: Healthfirst QHP |
$34.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$34.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.10
|
| Rate for Payer: SOMOS Essential |
$26.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.80
|
|
|
PR ECHO GUIDANCE RADIOTHERAPY
|
Professional
|
Both
|
$640.99
|
|
|
Service Code
|
HCPCS G6001 TC
|
| Min. Negotiated Rate |
$118.63 |
| Max. Negotiated Rate |
$381.31 |
| Rate for Payer: Cash Price |
$175.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$169.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$152.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$161.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$169.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.10
|
| Rate for Payer: Healthfirst Commercial |
$169.47
|
| Rate for Payer: Healthfirst Essential Plan |
$381.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.00
|
| Rate for Payer: Healthfirst QHP |
$169.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$118.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$169.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$118.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$169.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.10
|
| Rate for Payer: SOMOS Essential |
$127.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.47
|
|
|
PR ECHO GUIDANCE RADIOTHERAPY
|
Professional
|
Both
|
$767.97
|
|
|
Service Code
|
HCPCS G6001
|
| Min. Negotiated Rate |
$142.99 |
| Max. Negotiated Rate |
$459.61 |
| Rate for Payer: Cash Price |
$210.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$204.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.20
|
| Rate for Payer: Healthfirst Commercial |
$204.27
|
| Rate for Payer: Healthfirst Essential Plan |
$459.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.06
|
| Rate for Payer: Healthfirst QHP |
$204.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$204.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$204.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.20
|
| Rate for Payer: SOMOS Essential |
$153.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.27
|
|
|
PR ECHO R-T 2D W/PROBE PLACEMENT ONLY
|
Professional
|
Both
|
$45.22
|
|
|
Service Code
|
HCPCS 93313
|
| Min. Negotiated Rate |
$8.49 |
| Max. Negotiated Rate |
$27.29 |
| Rate for Payer: Amida Care Medicaid |
$25.25
|
| Rate for Payer: Cash Price |
$12.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.10
|
| Rate for Payer: Healthfirst Commercial |
$12.13
|
| Rate for Payer: Healthfirst Essential Plan |
$27.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.52
|
| Rate for Payer: Healthfirst QHP |
$12.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.10
|
| Rate for Payer: SOMOS Essential |
$9.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.13
|
|
|
PR ECHO TEE GUID TCAT ICAR/VESSEL STRUCTURAL INTVN
|
Professional
|
Both
|
$898.49
|
|
|
Service Code
|
HCPCS 93355
|
| Min. Negotiated Rate |
$121.67 |
| Max. Negotiated Rate |
$547.70 |
| Rate for Payer: Amida Care Medicaid |
$121.67
|
| Rate for Payer: Cash Price |
$245.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$243.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$219.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$219.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$231.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$243.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$231.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.56
|
| Rate for Payer: Healthfirst Commercial |
$243.42
|
| Rate for Payer: Healthfirst Essential Plan |
$547.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.25
|
| Rate for Payer: Healthfirst QHP |
$243.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$170.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$243.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$206.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$170.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$243.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$182.56
|
| Rate for Payer: SOMOS Essential |
$182.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$243.42
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$727.76
|
|
|
Service Code
|
HCPCS 93315 TC
|
| Min. Negotiated Rate |
$239.37 |
| Max. Negotiated Rate |
$239.37 |
| Rate for Payer: Amida Care Medicaid |
$239.37
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$495.08
|
|
|
Service Code
|
HCPCS 93315 26
|
| Min. Negotiated Rate |
$93.06 |
| Max. Negotiated Rate |
$299.12 |
| Rate for Payer: Amida Care Medicaid |
$239.37
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.70
|
| Rate for Payer: Healthfirst Commercial |
$132.94
|
| Rate for Payer: Healthfirst Essential Plan |
$299.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.29
|
| Rate for Payer: Healthfirst QHP |
$132.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.70
|
| Rate for Payer: SOMOS Essential |
$99.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.94
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT IMGNG I&R
|
Professional
|
Both
|
$1,222.83
|
|
|
Service Code
|
HCPCS 93315
|
| Min. Negotiated Rate |
$239.37 |
| Max. Negotiated Rate |
$239.37 |
| Rate for Payer: Amida Care Medicaid |
$239.37
|
|
|
PR ECHO TRANSESOPHAG CONGEN PROBE PLCMT ONLY
|
Professional
|
Both
|
$101.92
|
|
|
Service Code
|
HCPCS 93316
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$61.67 |
| Rate for Payer: Amida Care Medicaid |
$25.25
|
| Rate for Payer: Cash Price |
$28.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.56
|
| Rate for Payer: Healthfirst Commercial |
$27.41
|
| Rate for Payer: Healthfirst Essential Plan |
$61.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.04
|
| Rate for Payer: Healthfirst QHP |
$27.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.56
|
| Rate for Payer: SOMOS Essential |
$20.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.41
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$349.83
|
|
|
Service Code
|
HCPCS 93317 26
|
| Min. Negotiated Rate |
$66.68 |
| Max. Negotiated Rate |
$214.34 |
| Rate for Payer: Amida Care Medicaid |
$198.09
|
| Rate for Payer: Cash Price |
$95.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$85.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$85.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.44
|
| Rate for Payer: Healthfirst Commercial |
$95.26
|
| Rate for Payer: Healthfirst Essential Plan |
$214.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.50
|
| Rate for Payer: Healthfirst QHP |
$95.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$80.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.44
|
| Rate for Payer: SOMOS Essential |
$71.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.26
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$727.76
|
|
|
Service Code
|
HCPCS 93317 TC
|
| Min. Negotiated Rate |
$198.09 |
| Max. Negotiated Rate |
$198.09 |
| Rate for Payer: Amida Care Medicaid |
$198.09
|
|
|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$1,077.58
|
|
|
Service Code
|
HCPCS 93317
|
| Min. Negotiated Rate |
$198.09 |
| Max. Negotiated Rate |
$198.09 |
| Rate for Payer: Amida Care Medicaid |
$198.09
|
|
|
PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ
|
Professional
|
Both
|
$405.62
|
|
|
Service Code
|
HCPCS 93318 26
|
| Min. Negotiated Rate |
$77.36 |
| Max. Negotiated Rate |
$248.65 |
| Rate for Payer: Amida Care Medicaid |
$177.29
|
| Rate for Payer: Cash Price |
$109.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$110.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$104.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$110.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$104.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.88
|
| Rate for Payer: Healthfirst Commercial |
$110.51
|
| Rate for Payer: Healthfirst Essential Plan |
$248.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$104.98
|
| Rate for Payer: Healthfirst QHP |
$110.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$110.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$93.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$110.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$82.88
|
| Rate for Payer: SOMOS Essential |
$82.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$110.51
|
|
|
PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ
|
Professional
|
Both
|
$409.54
|
|
|
Service Code
|
HCPCS 93318 TC
|
| Min. Negotiated Rate |
$177.29 |
| Max. Negotiated Rate |
$177.29 |
| Rate for Payer: Amida Care Medicaid |
$177.29
|
|
|
PR ECHO TRANSESOPHAG MONTR CARDIAC PUMP FUNCTJ
|
Professional
|
Both
|
$815.15
|
|
|
Service Code
|
HCPCS 93318
|
| Min. Negotiated Rate |
$177.29 |
| Max. Negotiated Rate |
$177.29 |
| Rate for Payer: Amida Care Medicaid |
$177.29
|
|
|
PR ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY
|
Professional
|
Both
|
$970.69
|
|
|
Service Code
|
HCPCS 93314
|
| Min. Negotiated Rate |
$178.63 |
| Max. Negotiated Rate |
$574.18 |
| Rate for Payer: Amida Care Medicaid |
$219.58
|
| Rate for Payer: Cash Price |
$262.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$255.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$229.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$229.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$255.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.39
|
| Rate for Payer: Healthfirst Commercial |
$255.19
|
| Rate for Payer: Healthfirst Essential Plan |
$574.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.43
|
| Rate for Payer: Healthfirst QHP |
$255.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$178.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$255.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$216.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$178.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$255.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.39
|
| Rate for Payer: SOMOS Essential |
$191.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.19
|
|
|
PR ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY
|
Professional
|
Both
|
$367.22
|
|
|
Service Code
|
HCPCS 93314 26
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$219.58 |
| Rate for Payer: Amida Care Medicaid |
$219.58
|
| Rate for Payer: Cash Price |
$97.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.97
|
| Rate for Payer: Healthfirst Commercial |
$97.30
|
| Rate for Payer: Healthfirst Essential Plan |
$218.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.44
|
| Rate for Payer: Healthfirst QHP |
$97.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.97
|
| Rate for Payer: SOMOS Essential |
$72.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.30
|
|
|
PR ECHO TRANSESOPHAG R-T 2D IMG ACQUISJ I&R ONLY
|
Professional
|
Both
|
$603.47
|
|
|
Service Code
|
HCPCS 93314 TC
|
| Min. Negotiated Rate |
$110.52 |
| Max. Negotiated Rate |
$355.25 |
| Rate for Payer: Amida Care Medicaid |
$219.58
|
| Rate for Payer: Cash Price |
$164.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$142.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$150.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.42
|
| Rate for Payer: Healthfirst Commercial |
$157.89
|
| Rate for Payer: Healthfirst Essential Plan |
$355.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.00
|
| Rate for Payer: Healthfirst QHP |
$157.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$134.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.42
|
| Rate for Payer: SOMOS Essential |
$118.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.89
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$568.96
|
|
|
Service Code
|
HCPCS 93312 TC
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$337.79 |
| Rate for Payer: Amida Care Medicaid |
$253.06
|
| Rate for Payer: Cash Price |
$155.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.60
|
| Rate for Payer: Healthfirst Commercial |
$150.13
|
| Rate for Payer: Healthfirst Essential Plan |
$337.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.62
|
| Rate for Payer: Healthfirst QHP |
$150.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.60
|
| Rate for Payer: SOMOS Essential |
$112.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.13
|
|
