|
PR EPIGLOTTIDECTOMY
|
Professional
|
Both
|
$3,599.82
|
|
|
Service Code
|
HCPCS 31420
|
| Min. Negotiated Rate |
$673.89 |
| Max. Negotiated Rate |
$2,166.07 |
| Rate for Payer: Cash Price |
$974.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$962.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$866.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$866.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$914.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$962.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$914.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$962.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$962.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$722.02
|
| Rate for Payer: Healthfirst Commercial |
$962.70
|
| Rate for Payer: Healthfirst Essential Plan |
$2,166.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$914.57
|
| Rate for Payer: Healthfirst QHP |
$962.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$673.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$962.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$818.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$673.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$962.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$722.02
|
| Rate for Payer: SOMOS Essential |
$722.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$962.70
|
|
|
PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/U
|
Professional
|
Both
|
$2,749.39
|
|
|
Service Code
|
HCPCS 25450
|
| Min. Negotiated Rate |
$520.08 |
| Max. Negotiated Rate |
$1,671.68 |
| Rate for Payer: Cash Price |
$745.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$742.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$668.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$668.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$705.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$742.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$705.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$742.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$742.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$557.23
|
| Rate for Payer: Healthfirst Commercial |
$742.97
|
| Rate for Payer: Healthfirst Essential Plan |
$1,671.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$705.82
|
| Rate for Payer: Healthfirst QHP |
$742.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$520.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$742.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$631.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$520.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$742.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$557.23
|
| Rate for Payer: SOMOS Essential |
$557.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$742.97
|
|
|
PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS&ULNA
|
Professional
|
Both
|
$3,247.44
|
|
|
Service Code
|
HCPCS 25455
|
| Min. Negotiated Rate |
$612.46 |
| Max. Negotiated Rate |
$1,968.62 |
| Rate for Payer: Cash Price |
$878.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$874.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$787.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$787.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$831.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$874.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$831.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$874.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$874.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$656.21
|
| Rate for Payer: Healthfirst Commercial |
$874.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,968.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$831.19
|
| Rate for Payer: Healthfirst QHP |
$874.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$612.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$874.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$743.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$612.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$874.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$656.21
|
| Rate for Payer: SOMOS Essential |
$656.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$874.94
|
|
|
PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR
|
Professional
|
Both
|
$3,191.20
|
|
|
Service Code
|
HCPCS 27185
|
| Min. Negotiated Rate |
$601.66 |
| Max. Negotiated Rate |
$1,933.92 |
| Rate for Payer: Cash Price |
$863.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$859.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$773.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$773.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$816.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$859.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$816.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$859.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$859.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$644.64
|
| Rate for Payer: Healthfirst Commercial |
$859.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,933.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$816.54
|
| Rate for Payer: Healthfirst QHP |
$859.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$601.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$859.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$730.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$601.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$859.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$644.64
|
| Rate for Payer: SOMOS Essential |
$644.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$859.52
|
|
|
PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING
|
Professional
|
Both
|
$682.85
|
|
|
Service Code
|
HCPCS 59300
|
| Min. Negotiated Rate |
$124.87 |
| Max. Negotiated Rate |
$401.36 |
| Rate for Payer: Cash Price |
$181.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$178.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$160.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$169.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$178.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$169.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.78
|
| Rate for Payer: Healthfirst Commercial |
$178.38
|
| Rate for Payer: Healthfirst Essential Plan |
$401.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$169.46
|
| Rate for Payer: Healthfirst QHP |
$178.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$124.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$178.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$151.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$124.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$178.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$133.78
|
| Rate for Payer: SOMOS Essential |
$133.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$178.38
|
|
|
PR ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA
|
Professional
|
Both
|
$1,566.25
|
|
|
Service Code
|
HCPCS 43277
|
| Min. Negotiated Rate |
$294.90 |
| Max. Negotiated Rate |
$947.90 |
| Rate for Payer: Cash Price |
$425.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$421.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$379.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$379.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$400.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$421.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$400.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$421.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$421.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$315.97
|
| Rate for Payer: Healthfirst Commercial |
$421.29
|
| Rate for Payer: Healthfirst Essential Plan |
$947.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$400.23
|
| Rate for Payer: Healthfirst QHP |
$421.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$294.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$421.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$358.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$294.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$421.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$315.97
|
| Rate for Payer: SOMOS Essential |
$315.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$421.29
|
|
|
PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE
|
Professional
|
Both
|
$1,994.34
|
|
|
Service Code
|
HCPCS 43276
|
| Min. Negotiated Rate |
$374.58 |
| Max. Negotiated Rate |
$1,204.00 |
| Rate for Payer: Cash Price |
$542.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$535.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$481.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$481.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$508.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$535.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$508.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$535.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$535.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$401.33
|
| Rate for Payer: Healthfirst Commercial |
$535.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,204.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$508.35
|
| Rate for Payer: Healthfirst QHP |
$535.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$374.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$535.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$454.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$374.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$535.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$401.33
|
| Rate for Payer: SOMOS Essential |
$401.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$535.11
|
|
|
PR ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD
|
Professional
|
Both
|
$1,791.34
|
|
|
Service Code
|
HCPCS 43265
|
| Min. Negotiated Rate |
$336.30 |
| Max. Negotiated Rate |
$1,080.97 |
| Rate for Payer: Cash Price |
$487.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$480.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$432.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$432.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$456.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$480.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$456.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$480.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$480.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$360.32
|
| Rate for Payer: Healthfirst Commercial |
$480.43
|
| Rate for Payer: Healthfirst Essential Plan |
$1,080.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$456.41
|
| Rate for Payer: Healthfirst QHP |
$480.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$336.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$480.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$408.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$336.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$480.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$360.32
|
| Rate for Payer: SOMOS Essential |
$360.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$480.43
|
|
|
PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING
|
Professional
|
Both
|
$1,334.34
|
|
|
Service Code
|
HCPCS 43260
|
| Min. Negotiated Rate |
$251.62 |
| Max. Negotiated Rate |
$808.78 |
| Rate for Payer: Cash Price |
$363.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$359.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$323.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$341.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$359.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$341.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$359.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$359.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$269.60
|
| Rate for Payer: Healthfirst Commercial |
$359.46
|
| Rate for Payer: Healthfirst Essential Plan |
$808.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$341.49
|
| Rate for Payer: Healthfirst QHP |
$359.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$251.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$359.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$305.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$251.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$359.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$269.60
|
| Rate for Payer: SOMOS Essential |
$269.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$359.46
|
|
|
PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT
|
Professional
|
Both
|
$1,508.26
|
|
|
Service Code
|
HCPCS 43264
|
| Min. Negotiated Rate |
$284.27 |
| Max. Negotiated Rate |
$913.73 |
| Rate for Payer: Cash Price |
$409.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$406.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$365.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$365.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$385.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$406.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$385.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$406.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$304.57
|
| Rate for Payer: Healthfirst Commercial |
$406.10
|
| Rate for Payer: Healthfirst Essential Plan |
$913.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$385.80
|
| Rate for Payer: Healthfirst QHP |
$406.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$284.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$406.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$345.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$284.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$406.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$304.57
|
| Rate for Payer: SOMOS Essential |
$304.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$406.10
|
|
|
PR ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT
|
Professional
|
Both
|
$1,556.91
|
|
|
Service Code
|
HCPCS 43275
|
| Min. Negotiated Rate |
$293.40 |
| Max. Negotiated Rate |
$943.07 |
| Rate for Payer: Cash Price |
$423.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$419.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$377.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$377.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$398.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$419.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$398.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$419.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$419.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$314.36
|
| Rate for Payer: Healthfirst Commercial |
$419.14
|
| Rate for Payer: Healthfirst Essential Plan |
$943.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$398.18
|
| Rate for Payer: Healthfirst QHP |
$419.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$293.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$419.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$356.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$293.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$419.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$314.36
|
| Rate for Payer: SOMOS Essential |
$314.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$419.14
|
|
|
PR ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT
|
Professional
|
Both
|
$1,915.31
|
|
|
Service Code
|
HCPCS 43274
|
| Min. Negotiated Rate |
$360.25 |
| Max. Negotiated Rate |
$1,157.94 |
| Rate for Payer: Cash Price |
$521.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$514.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$463.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$463.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$488.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$514.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$488.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$514.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$514.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$385.98
|
| Rate for Payer: Healthfirst Commercial |
$514.64
|
| Rate for Payer: Healthfirst Essential Plan |
$1,157.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$488.91
|
| Rate for Payer: Healthfirst QHP |
$514.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$360.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$514.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$437.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$360.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$514.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$385.98
|
| Rate for Payer: SOMOS Essential |
$385.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$514.64
|
|
|
PR ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE
|
Professional
|
Both
|
$1,790.08
|
|
|
Service Code
|
HCPCS 43278
|
| Min. Negotiated Rate |
$337.36 |
| Max. Negotiated Rate |
$1,084.37 |
| Rate for Payer: Cash Price |
$487.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$481.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$433.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$433.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$457.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$481.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$457.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$481.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$481.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Healthfirst Commercial |
$481.94
|
| Rate for Payer: Healthfirst Essential Plan |
$1,084.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$457.84
|
| Rate for Payer: Healthfirst QHP |
$481.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$337.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$481.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$409.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$337.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$481.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$361.45
|
| Rate for Payer: SOMOS Essential |
$361.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$481.94
|
|
|
PR ERCP W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,404.27
|
|
|
Service Code
|
HCPCS 43261
|
| Min. Negotiated Rate |
$263.69 |
| Max. Negotiated Rate |
$847.58 |
| Rate for Payer: Cash Price |
$381.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$376.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$339.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$339.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$357.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$376.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$357.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$376.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$282.52
|
| Rate for Payer: Healthfirst Commercial |
$376.70
|
| Rate for Payer: Healthfirst Essential Plan |
$847.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$357.87
|
| Rate for Payer: Healthfirst QHP |
$376.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$263.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$376.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$320.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$263.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$376.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$282.52
|
| Rate for Payer: SOMOS Essential |
$282.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$376.70
|
|
|
PR ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI
|
Professional
|
Both
|
$1,480.75
|
|
|
Service Code
|
HCPCS 43263
|
| Min. Negotiated Rate |
$278.91 |
| Max. Negotiated Rate |
$896.49 |
| Rate for Payer: Cash Price |
$402.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$398.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$358.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$358.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$378.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$398.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$378.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$398.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$398.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$298.83
|
| Rate for Payer: Healthfirst Commercial |
$398.44
|
| Rate for Payer: Healthfirst Essential Plan |
$896.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$378.52
|
| Rate for Payer: Healthfirst QHP |
$398.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$278.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$398.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$338.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$278.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$398.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$298.83
|
| Rate for Payer: SOMOS Essential |
$298.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$398.44
|
|
|
PR ERCP W/SPHINCTEROTOMY/PAPILLOTOMY
|
Professional
|
Both
|
$1,479.31
|
|
|
Service Code
|
HCPCS 43262
|
| Min. Negotiated Rate |
$278.21 |
| Max. Negotiated Rate |
$894.24 |
| Rate for Payer: Cash Price |
$401.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$397.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$357.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$357.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$377.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$397.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$377.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$397.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$397.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$298.08
|
| Rate for Payer: Healthfirst Commercial |
$397.44
|
| Rate for Payer: Healthfirst Essential Plan |
$894.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$377.57
|
| Rate for Payer: Healthfirst QHP |
$397.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$278.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$397.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$337.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$278.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$397.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$298.08
|
| Rate for Payer: SOMOS Essential |
$298.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$397.44
|
|
|
PR ERGONOVINE PROVOCATION TST
|
Professional
|
Both
|
$243.81
|
|
|
Service Code
|
HCPCS 93024 TC
|
| Min. Negotiated Rate |
$48.57 |
| Max. Negotiated Rate |
$156.13 |
| Rate for Payer: Cash Price |
$69.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.04
|
| Rate for Payer: Healthfirst Commercial |
$69.39
|
| Rate for Payer: Healthfirst Essential Plan |
$156.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.92
|
| Rate for Payer: Healthfirst QHP |
$69.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.04
|
| Rate for Payer: SOMOS Essential |
$52.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.39
|
|
|
PR ERGONOVINE PROVOCATION TST
|
Professional
|
Both
|
$214.97
|
|
|
Service Code
|
HCPCS 93024 26
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Cash Price |
$59.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.02
|
| Rate for Payer: Healthfirst Commercial |
$58.69
|
| Rate for Payer: Healthfirst Essential Plan |
$132.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.76
|
| Rate for Payer: Healthfirst QHP |
$58.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.02
|
| Rate for Payer: SOMOS Essential |
$44.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.69
|
|
|
PR ERGONOVINE PROVOCATION TST
|
Professional
|
Both
|
$458.82
|
|
|
Service Code
|
HCPCS 93024
|
| Min. Negotiated Rate |
$89.66 |
| Max. Negotiated Rate |
$288.20 |
| Rate for Payer: Cash Price |
$128.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$128.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$115.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$115.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$128.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.07
|
| Rate for Payer: Healthfirst Commercial |
$128.09
|
| Rate for Payer: Healthfirst Essential Plan |
$288.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.69
|
| Rate for Payer: Healthfirst QHP |
$128.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$128.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$128.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.07
|
| Rate for Payer: SOMOS Essential |
$96.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$128.09
|
|
|
PR ESCHAROTOMY EACH ADDITIONAL INCISION
|
Professional
|
Both
|
$364.70
|
|
|
Service Code
|
HCPCS 16036
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$218.56 |
| Rate for Payer: Cash Price |
$97.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.86
|
| Rate for Payer: Healthfirst Commercial |
$97.14
|
| Rate for Payer: Healthfirst Essential Plan |
$218.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.28
|
| Rate for Payer: Healthfirst QHP |
$97.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.86
|
| Rate for Payer: SOMOS Essential |
$72.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.14
|
|
|
PR ESCHAROTOMY FIRST INCISION
|
Professional
|
Both
|
$828.94
|
|
|
Service Code
|
HCPCS 16035
|
| Min. Negotiated Rate |
$156.86 |
| Max. Negotiated Rate |
$504.18 |
| Rate for Payer: Cash Price |
$226.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$224.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$212.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$224.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$212.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.06
|
| Rate for Payer: Healthfirst Commercial |
$224.08
|
| Rate for Payer: Healthfirst Essential Plan |
$504.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.88
|
| Rate for Payer: Healthfirst QHP |
$224.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$224.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$224.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.06
|
| Rate for Payer: SOMOS Essential |
$168.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.08
|
|
|
PR ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH
|
Professional
|
Both
|
$6,152.86
|
|
|
Service Code
|
HCPCS 43325
|
| Min. Negotiated Rate |
$1,137.50 |
| Max. Negotiated Rate |
$3,656.25 |
| Rate for Payer: Cash Price |
$1,636.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,625.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,462.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,462.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,543.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,625.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,543.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,625.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,218.75
|
| Rate for Payer: Healthfirst Commercial |
$1,625.00
|
| Rate for Payer: Healthfirst Essential Plan |
$3,656.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,543.75
|
| Rate for Payer: Healthfirst QHP |
$1,625.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,137.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,625.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,381.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,137.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,625.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,218.75
|
| Rate for Payer: SOMOS Essential |
$1,218.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,625.00
|
|
|
PR ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY
|
Professional
|
Both
|
$3,700.83
|
|
|
Service Code
|
HCPCS 43327
|
| Min. Negotiated Rate |
$699.34 |
| Max. Negotiated Rate |
$2,247.89 |
| Rate for Payer: Cash Price |
$980.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$999.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$899.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$899.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$949.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$999.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$949.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$999.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$999.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$749.29
|
| Rate for Payer: Healthfirst Commercial |
$999.06
|
| Rate for Payer: Healthfirst Essential Plan |
$2,247.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$949.11
|
| Rate for Payer: Healthfirst QHP |
$999.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$699.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$999.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$849.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$699.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$999.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$749.29
|
| Rate for Payer: SOMOS Essential |
$749.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$999.06
|
|
|
PR ESOPG/GSTR FUNDOPLASTY W/THORACOTOMY
|
Professional
|
Both
|
$5,013.26
|
|
|
Service Code
|
HCPCS 43328
|
| Min. Negotiated Rate |
$923.15 |
| Max. Negotiated Rate |
$2,967.28 |
| Rate for Payer: Cash Price |
$1,332.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,318.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,186.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,186.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,252.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,318.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,252.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,318.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,318.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$989.09
|
| Rate for Payer: Healthfirst Commercial |
$1,318.79
|
| Rate for Payer: Healthfirst Essential Plan |
$2,967.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,252.85
|
| Rate for Payer: Healthfirst QHP |
$1,318.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$923.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,318.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,120.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$923.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,318.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$989.09
|
| Rate for Payer: SOMOS Essential |
$989.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,318.79
|
|
|
PR ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE
|
Professional
|
Both
|
$882.60
|
|
|
Service Code
|
HCPCS 43460
|
| Min. Negotiated Rate |
$167.16 |
| Max. Negotiated Rate |
$537.30 |
| Rate for Payer: Cash Price |
$239.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$238.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$214.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$214.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$226.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$238.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$226.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$238.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$238.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.10
|
| Rate for Payer: Healthfirst Commercial |
$238.80
|
| Rate for Payer: Healthfirst Essential Plan |
$537.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$226.86
|
| Rate for Payer: Healthfirst QHP |
$238.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$167.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$238.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$202.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$167.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$238.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$179.10
|
| Rate for Payer: SOMOS Essential |
$179.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$238.80
|
|
