|
PR EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE
|
Professional
|
Both
|
$850.96
|
|
|
Service Code
|
HCPCS 43246
|
| Min. Negotiated Rate |
$159.37 |
| Max. Negotiated Rate |
$512.26 |
| Rate for Payer: Cash Price |
$229.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$227.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$204.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$204.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$227.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$227.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$227.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.75
|
| Rate for Payer: Healthfirst Commercial |
$227.67
|
| Rate for Payer: Healthfirst Essential Plan |
$512.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$216.29
|
| Rate for Payer: Healthfirst QHP |
$227.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$159.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$227.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$193.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$159.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$227.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.75
|
| Rate for Payer: SOMOS Essential |
$170.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.67
|
|
|
PR EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH
|
Professional
|
Both
|
$816.90
|
|
|
Service Code
|
HCPCS 43251
|
| Min. Negotiated Rate |
$153.91 |
| Max. Negotiated Rate |
$494.71 |
| Rate for Payer: Cash Price |
$221.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$219.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$197.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$197.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$208.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$219.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$208.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$219.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$219.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.90
|
| Rate for Payer: Healthfirst Commercial |
$219.87
|
| Rate for Payer: Healthfirst Essential Plan |
$494.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$208.88
|
| Rate for Payer: Healthfirst QHP |
$219.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$153.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$219.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$186.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$153.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$219.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$164.90
|
| Rate for Payer: SOMOS Essential |
$164.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$219.87
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$577.08
|
|
|
Service Code
|
HCPCS 43239
|
| Min. Negotiated Rate |
$108.77 |
| Max. Negotiated Rate |
$349.61 |
| Rate for Payer: Cash Price |
$157.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$155.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.53
|
| Rate for Payer: Healthfirst Commercial |
$155.38
|
| Rate for Payer: Healthfirst Essential Plan |
$349.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.61
|
| Rate for Payer: Healthfirst QHP |
$155.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.53
|
| Rate for Payer: SOMOS Essential |
$116.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.38
|
|
|
PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD
|
Professional
|
Both
|
$831.18
|
|
|
Service Code
|
HCPCS 43255
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$504.65 |
| Rate for Payer: Cash Price |
$225.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$224.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$213.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$224.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$213.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.22
|
| Rate for Payer: Healthfirst Commercial |
$224.29
|
| Rate for Payer: Healthfirst Essential Plan |
$504.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$213.08
|
| Rate for Payer: Healthfirst QHP |
$224.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$157.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$224.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$157.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$224.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.22
|
| Rate for Payer: SOMOS Essential |
$168.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.29
|
|
|
PR EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION
|
Professional
|
Both
|
$1,119.69
|
|
|
Service Code
|
HCPCS 43254
|
| Min. Negotiated Rate |
$211.27 |
| Max. Negotiated Rate |
$679.10 |
| Rate for Payer: Cash Price |
$304.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$301.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$271.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$271.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$286.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$301.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$286.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$301.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$301.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$226.37
|
| Rate for Payer: Healthfirst Commercial |
$301.82
|
| Rate for Payer: Healthfirst Essential Plan |
$679.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$286.73
|
| Rate for Payer: Healthfirst QHP |
$301.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$211.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$301.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$256.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$211.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$301.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$226.37
|
| Rate for Payer: SOMOS Essential |
$226.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$301.82
|
|
|
PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST
|
Professional
|
Both
|
$1,621.59
|
|
|
Service Code
|
HCPCS 43240
|
| Min. Negotiated Rate |
$305.06 |
| Max. Negotiated Rate |
$980.55 |
| Rate for Payer: Cash Price |
$441.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$435.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$392.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$392.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$414.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$435.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$414.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$435.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$435.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$326.85
|
| Rate for Payer: Healthfirst Commercial |
$435.80
|
| Rate for Payer: Healthfirst Essential Plan |
$980.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.01
|
| Rate for Payer: Healthfirst QHP |
$435.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$305.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$435.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$370.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$305.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$435.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$326.85
|
| Rate for Payer: SOMOS Essential |
$326.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$435.80
|
|
|
PR EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER
|
Professional
|
Both
|
$1,090.78
|
|
|
Service Code
|
HCPCS 43253
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$660.22 |
| Rate for Payer: Cash Price |
$295.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$264.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$264.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$278.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$278.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$293.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$220.07
|
| Rate for Payer: Healthfirst Commercial |
$293.43
|
| Rate for Payer: Healthfirst Essential Plan |
$660.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$278.76
|
| Rate for Payer: Healthfirst QHP |
$293.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$205.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$293.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$249.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$205.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$220.07
|
| Rate for Payer: SOMOS Essential |
$220.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.43
|
|
|
PR EGST W/WO VAGOTOMY&PYLOROPLASTY TABDL/TTHRC AP
|
Professional
|
Both
|
$6,327.13
|
|
|
Service Code
|
HCPCS 43320
|
| Min. Negotiated Rate |
$1,169.90 |
| Max. Negotiated Rate |
$3,760.40 |
| Rate for Payer: Cash Price |
$1,684.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,671.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,504.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,504.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,587.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,671.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,587.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,671.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,671.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,253.47
|
| Rate for Payer: Healthfirst Commercial |
$1,671.29
|
| Rate for Payer: Healthfirst Essential Plan |
$3,760.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,587.73
|
| Rate for Payer: Healthfirst QHP |
$1,671.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,169.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,671.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,420.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,169.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,671.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,253.47
|
| Rate for Payer: SOMOS Essential |
$1,253.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,671.29
|
|
|
PR EKG FOR INITIAL PREVENT EXAM
|
Professional
|
Both
|
$61.25
|
|
|
Service Code
|
HCPCS G0403
|
| Min. Negotiated Rate |
$11.49 |
| Max. Negotiated Rate |
$36.92 |
| 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 EKG INTERPRET & REPORT PREVE
|
Professional
|
Both
|
$32.66
|
|
|
Service Code
|
HCPCS G0405
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$19.80 |
| 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 EKG TRACING FOR INITIAL PREV
|
Professional
|
Both
|
$28.60
|
|
|
Service Code
|
HCPCS G0404
|
| 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 ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 MIN
|
Professional
|
Both
|
$206.01
|
|
|
Service Code
|
HCPCS 95983
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$121.84 |
| Rate for Payer: Amida Care Medicaid |
$27.59
|
| Rate for Payer: Cash Price |
$55.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.61
|
| Rate for Payer: Healthfirst Commercial |
$54.15
|
| Rate for Payer: Healthfirst Essential Plan |
$121.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.44
|
| Rate for Payer: Healthfirst QHP |
$54.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.61
|
| Rate for Payer: SOMOS Essential |
$40.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.15
|
|
|
PR ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN
|
Professional
|
Both
|
$179.59
|
|
|
Service Code
|
HCPCS 95984
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$107.55 |
| Rate for Payer: Amida Care Medicaid |
$24.11
|
| Rate for Payer: Cash Price |
$48.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.85
|
| Rate for Payer: Healthfirst Commercial |
$47.80
|
| Rate for Payer: Healthfirst Essential Plan |
$107.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.41
|
| Rate for Payer: Healthfirst QHP |
$47.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.85
|
| Rate for Payer: SOMOS Essential |
$35.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.80
|
|
|
PR ELEC ALYS IMPLT CPLX CN NPGT PRGRMG
|
Professional
|
Both
|
$216.41
|
|
|
Service Code
|
HCPCS 95977
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$124.74 |
| Rate for Payer: Amida Care Medicaid |
$29.05
|
| Rate for Payer: Cash Price |
$58.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$55.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$52.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$55.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$52.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.58
|
| Rate for Payer: Healthfirst Commercial |
$55.44
|
| Rate for Payer: Healthfirst Essential Plan |
$124.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$52.67
|
| Rate for Payer: Healthfirst QHP |
$55.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$55.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$41.58
|
| Rate for Payer: SOMOS Essential |
$41.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.44
|
|
|
PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
Professional
|
Both
|
$170.70
|
|
|
Service Code
|
HCPCS 95972
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$98.82 |
| Rate for Payer: Amida Care Medicaid |
$37.93
|
| Rate for Payer: Cash Price |
$45.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.94
|
| Rate for Payer: Healthfirst Commercial |
$43.92
|
| Rate for Payer: Healthfirst Essential Plan |
$98.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.72
|
| Rate for Payer: Healthfirst QHP |
$43.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.94
|
| Rate for Payer: SOMOS Essential |
$32.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.92
|
|
|
PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING
|
Professional
|
Both
|
$77.77
|
|
|
Service Code
|
HCPCS 95970
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Amida Care Medicaid |
$11.06
|
| Rate for Payer: Cash Price |
$20.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.38
|
| Rate for Payer: Healthfirst Commercial |
$20.51
|
| Rate for Payer: Healthfirst Essential Plan |
$46.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.48
|
| Rate for Payer: Healthfirst QHP |
$20.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.38
|
| Rate for Payer: SOMOS Essential |
$15.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.51
|
|
|
PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG
|
Professional
|
Both
|
$159.99
|
|
|
Service Code
|
HCPCS 95971
|
| Min. Negotiated Rate |
$18.93 |
| Max. Negotiated Rate |
$95.87 |
| Rate for Payer: Amida Care Medicaid |
$18.93
|
| Rate for Payer: Cash Price |
$43.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.96
|
| Rate for Payer: Healthfirst Commercial |
$42.61
|
| Rate for Payer: Healthfirst Essential Plan |
$95.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.48
|
| Rate for Payer: Healthfirst QHP |
$42.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.96
|
| Rate for Payer: SOMOS Essential |
$31.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.61
|
|
|
PR ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Professional
|
Both
|
$160.90
|
|
|
Service Code
|
HCPCS 95976
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Amida Care Medicaid |
$21.80
|
| Rate for Payer: Cash Price |
$43.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.79
|
| Rate for Payer: Healthfirst Commercial |
$41.05
|
| Rate for Payer: Healthfirst Essential Plan |
$92.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.00
|
| Rate for Payer: Healthfirst QHP |
$41.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$28.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$34.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$28.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$30.79
|
| Rate for Payer: SOMOS Essential |
$30.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.05
|
|
|
PR ELEC ALYS NSTIM GEN GASTRIC SBSQ W/O REPRGRMG
|
Professional
|
Both
|
$78.44
|
|
|
Service Code
|
HCPCS 95981
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$45.92 |
| Rate for Payer: Amida Care Medicaid |
$8.84
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.31
|
| Rate for Payer: Healthfirst Commercial |
$20.41
|
| Rate for Payer: Healthfirst Essential Plan |
$45.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.39
|
| Rate for Payer: Healthfirst QHP |
$20.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.31
|
| Rate for Payer: SOMOS Essential |
$15.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.41
|
|
|
PR ELEC ALYS NSTIM PLS GEN GASTRIC INTRAOP W/PRGRMG
|
Professional
|
Both
|
$203.95
|
|
|
Service Code
|
HCPCS 95980
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$118.48 |
| Rate for Payer: Amida Care Medicaid |
$23.32
|
| Rate for Payer: Cash Price |
$53.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.49
|
| Rate for Payer: Healthfirst Commercial |
$52.66
|
| Rate for Payer: Healthfirst Essential Plan |
$118.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.03
|
| Rate for Payer: Healthfirst QHP |
$52.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.49
|
| Rate for Payer: SOMOS Essential |
$39.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.66
|
|
|
PR ELEC ALYS NSTIM PLS GEN GASTRIC SBSQ W/REPRGRMG
|
Professional
|
Both
|
$158.80
|
|
|
Service Code
|
HCPCS 95982
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$96.41 |
| Rate for Payer: Amida Care Medicaid |
$17.63
|
| Rate for Payer: Cash Price |
$42.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.14
|
| Rate for Payer: Healthfirst Commercial |
$42.85
|
| Rate for Payer: Healthfirst Essential Plan |
$96.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.71
|
| Rate for Payer: Healthfirst QHP |
$42.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.14
|
| Rate for Payer: SOMOS Essential |
$32.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.85
|
|
|
PR ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP
|
Professional
|
Both
|
$191.84
|
|
|
Service Code
|
HCPCS 62370
|
| Min. Negotiated Rate |
$36.09 |
| Max. Negotiated Rate |
$115.99 |
| Rate for Payer: Cash Price |
$51.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.66
|
| Rate for Payer: Healthfirst Commercial |
$51.55
|
| Rate for Payer: Healthfirst Essential Plan |
$115.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.97
|
| Rate for Payer: Healthfirst QHP |
$51.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$51.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.66
|
| Rate for Payer: SOMOS Essential |
$38.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.55
|
|
|
PR ELEC STIM OTHER THAN WOUND
|
Professional
|
Both
|
$49.74
|
|
|
Service Code
|
HCPCS G0283
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$31.93 |
| Rate for Payer: Cash Price |
$13.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.64
|
| Rate for Payer: Healthfirst Commercial |
$14.19
|
| Rate for Payer: Healthfirst Essential Plan |
$31.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.48
|
| Rate for Payer: Healthfirst QHP |
$14.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.64
|
| Rate for Payer: SOMOS Essential |
$10.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.19
|
|
|
PR ELEC STIM UNATTEND FOR PRESS
|
Professional
|
Both
|
$49.74
|
|
|
Service Code
|
HCPCS G0281
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$29.32 |
| Rate for Payer: Cash Price |
$13.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.77
|
| Rate for Payer: Healthfirst Commercial |
$13.03
|
| Rate for Payer: Healthfirst Essential Plan |
$29.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.38
|
| Rate for Payer: Healthfirst QHP |
$13.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.77
|
| Rate for Payer: SOMOS Essential |
$9.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.03
|
|
|
PR ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG
|
Professional
|
Both
|
$144.62
|
|
|
Service Code
|
HCPCS 62368
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: Cash Price |
$38.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.71
|
| Rate for Payer: Healthfirst Commercial |
$38.28
|
| Rate for Payer: Healthfirst Essential Plan |
$86.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.37
|
| Rate for Payer: Healthfirst QHP |
$38.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.71
|
| Rate for Payer: SOMOS Essential |
$28.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.28
|
|
