|
PR ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION
|
Professional
|
Both
|
$36.79
|
|
|
Service Code
|
HCPCS 91013 26
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Amida Care Medicaid |
$11.09
|
| Rate for Payer: Cash Price |
$10.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.44
|
| Rate for Payer: Healthfirst Commercial |
$9.92
|
| Rate for Payer: Healthfirst Essential Plan |
$22.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.42
|
| Rate for Payer: Healthfirst QHP |
$9.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.44
|
| Rate for Payer: SOMOS Essential |
$7.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.92
|
|
|
PR ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION
|
Professional
|
Both
|
$108.64
|
|
|
Service Code
|
HCPCS 91013
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Amida Care Medicaid |
$11.09
|
| Rate for Payer: Cash Price |
$29.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$28.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.42
|
| Rate for Payer: Healthfirst Commercial |
$28.56
|
| Rate for Payer: Healthfirst Essential Plan |
$64.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.13
|
| Rate for Payer: Healthfirst QHP |
$28.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$28.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21.42
|
| Rate for Payer: SOMOS Essential |
$21.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.56
|
|
|
PR ESOPHAGEAL MOTILITY STD W/I&R STIM/PERFUSION
|
Professional
|
Both
|
$71.89
|
|
|
Service Code
|
HCPCS 91013 TC
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$41.92 |
| Rate for Payer: Amida Care Medicaid |
$11.09
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.97
|
| Rate for Payer: Healthfirst Commercial |
$18.63
|
| Rate for Payer: Healthfirst Essential Plan |
$41.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.70
|
| Rate for Payer: Healthfirst QHP |
$18.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.97
|
| Rate for Payer: SOMOS Essential |
$13.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.63
|
|
|
PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT
|
Professional
|
Both
|
$683.97
|
|
|
Service Code
|
HCPCS 91010 TC
|
| Min. Negotiated Rate |
$124.77 |
| Max. Negotiated Rate |
$401.04 |
| Rate for Payer: Amida Care Medicaid |
$161.12
|
| Rate for Payer: Cash Price |
$186.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$178.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$160.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$160.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$169.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$178.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$169.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.68
|
| Rate for Payer: Healthfirst Commercial |
$178.24
|
| Rate for Payer: Healthfirst Essential Plan |
$401.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$169.33
|
| Rate for Payer: Healthfirst QHP |
$178.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$124.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$178.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$151.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$124.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$178.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$133.68
|
| Rate for Payer: SOMOS Essential |
$133.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$178.24
|
|
|
PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT
|
Professional
|
Both
|
$255.78
|
|
|
Service Code
|
HCPCS 91010 26
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$161.12 |
| Rate for Payer: Amida Care Medicaid |
$161.12
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.69
|
| Rate for Payer: Healthfirst Commercial |
$68.92
|
| Rate for Payer: Healthfirst Essential Plan |
$155.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.47
|
| Rate for Payer: Healthfirst QHP |
$68.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.69
|
| Rate for Payer: SOMOS Essential |
$51.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.92
|
|
|
PR ESOPHAGEAL MOTILITY STUDY W/INTERP&RPT
|
Professional
|
Both
|
$939.75
|
|
|
Service Code
|
HCPCS 91010
|
| Min. Negotiated Rate |
$161.12 |
| Max. Negotiated Rate |
$556.11 |
| Rate for Payer: Amida Care Medicaid |
$161.12
|
| Rate for Payer: Cash Price |
$256.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$222.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$222.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$234.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$234.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$247.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.37
|
| Rate for Payer: Healthfirst Commercial |
$247.16
|
| Rate for Payer: Healthfirst Essential Plan |
$556.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$234.80
|
| Rate for Payer: Healthfirst QHP |
$247.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$173.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$210.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$173.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$185.37
|
| Rate for Payer: SOMOS Essential |
$185.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.16
|
|
|
PR ESOPHAGECTOMY DISTAL 2/3 W/LAPAROSCOPIC MOBLJ
|
Professional
|
Both
|
$15,840.30
|
|
|
Service Code
|
HCPCS 43287
|
| Min. Negotiated Rate |
$2,917.15 |
| Max. Negotiated Rate |
$9,376.56 |
| Rate for Payer: Cash Price |
$4,215.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,167.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,750.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,750.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,958.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,167.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,958.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,167.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,167.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,125.52
|
| Rate for Payer: Healthfirst Commercial |
$4,167.36
|
| Rate for Payer: Healthfirst Essential Plan |
$9,376.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,958.99
|
| Rate for Payer: Healthfirst QHP |
$4,167.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,917.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,167.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,542.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,917.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,167.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,125.52
|
| Rate for Payer: SOMOS Essential |
$3,125.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,167.36
|
|
|
PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/LAPS MOBLJ
|
Professional
|
Both
|
$14,230.62
|
|
|
Service Code
|
HCPCS 43286
|
| Min. Negotiated Rate |
$2,626.84 |
| Max. Negotiated Rate |
$8,443.42 |
| Rate for Payer: Cash Price |
$3,772.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,752.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,377.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,377.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,565.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,752.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,565.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,752.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,752.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,814.47
|
| Rate for Payer: Healthfirst Commercial |
$3,752.63
|
| Rate for Payer: Healthfirst Essential Plan |
$8,443.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,565.00
|
| Rate for Payer: Healthfirst QHP |
$3,752.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,626.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,752.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,189.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,626.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,752.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,814.47
|
| Rate for Payer: SOMOS Essential |
$2,814.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,752.63
|
|
|
PR ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ
|
Professional
|
Both
|
$16,724.58
|
|
|
Service Code
|
HCPCS 43288
|
| Min. Negotiated Rate |
$3,077.95 |
| Max. Negotiated Rate |
$9,893.41 |
| Rate for Payer: Cash Price |
$4,443.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,397.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,957.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,957.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,177.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,397.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,177.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,397.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,397.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,297.80
|
| Rate for Payer: Healthfirst Commercial |
$4,397.07
|
| Rate for Payer: Healthfirst Essential Plan |
$9,893.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,177.22
|
| Rate for Payer: Healthfirst QHP |
$4,397.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,077.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,397.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,737.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3,077.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,397.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,297.80
|
| Rate for Payer: SOMOS Essential |
$3,297.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,397.07
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY SUBMUCOSAL INJECTION
|
Professional
|
Both
|
$571.59
|
|
|
Service Code
|
HCPCS 43236
|
| 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 ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$512.61
|
|
|
Service Code
|
HCPCS 43235
|
| Min. Negotiated Rate |
$97.13 |
| Max. Negotiated Rate |
$312.21 |
| Rate for Payer: Cash Price |
$139.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.07
|
| Rate for Payer: Healthfirst Commercial |
$138.76
|
| Rate for Payer: Healthfirst Essential Plan |
$312.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$131.82
|
| Rate for Payer: Healthfirst QHP |
$138.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$138.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$104.07
|
| Rate for Payer: SOMOS Essential |
$104.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.76
|
|
|
PR ESOPHAGOGASTRODUODENOSCOPY US SCOPE W/ADJ STRXRS
|
Professional
|
Both
|
$812.88
|
|
|
Service Code
|
HCPCS 43237
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$491.40 |
| Rate for Payer: Cash Price |
$220.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$218.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$196.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$207.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$218.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$207.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$218.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$218.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.80
|
| Rate for Payer: Healthfirst Commercial |
$218.40
|
| Rate for Payer: Healthfirst Essential Plan |
$491.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$207.48
|
| Rate for Payer: Healthfirst QHP |
$218.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$152.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$218.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$185.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$152.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$218.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$163.80
|
| Rate for Payer: SOMOS Essential |
$163.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$218.40
|
|
|
PR ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT ABDL APPR
|
Professional
|
Both
|
$6,245.19
|
|
|
Service Code
|
HCPCS 43340
|
| Min. Negotiated Rate |
$1,155.47 |
| Max. Negotiated Rate |
$3,714.01 |
| Rate for Payer: Cash Price |
$1,663.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,650.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,485.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,485.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,568.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,650.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,568.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,650.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,650.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,238.00
|
| Rate for Payer: Healthfirst Commercial |
$1,650.67
|
| Rate for Payer: Healthfirst Essential Plan |
$3,714.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,568.14
|
| Rate for Payer: Healthfirst QHP |
$1,650.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,155.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,650.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,403.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,155.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,650.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,238.00
|
| Rate for Payer: SOMOS Essential |
$1,238.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,650.67
|
|
|
PR ESOPHAGOJEJUNOSTOMY W/O TOT GSTRCT THRC APPR
|
Professional
|
Both
|
$6,247.29
|
|
|
Service Code
|
HCPCS 43341
|
| Min. Negotiated Rate |
$1,154.98 |
| Max. Negotiated Rate |
$3,712.43 |
| Rate for Payer: Cash Price |
$1,666.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,649.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,484.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,484.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,567.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,649.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,567.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,649.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,649.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,237.48
|
| Rate for Payer: Healthfirst Commercial |
$1,649.97
|
| Rate for Payer: Healthfirst Essential Plan |
$3,712.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,567.47
|
| Rate for Payer: Healthfirst QHP |
$1,649.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,154.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,649.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,402.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,154.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,649.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,237.48
|
| Rate for Payer: SOMOS Essential |
$1,237.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,649.97
|
|
|
PR ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH
|
Professional
|
Both
|
$6,048.56
|
|
|
Service Code
|
HCPCS 43330
|
| Min. Negotiated Rate |
$1,118.94 |
| Max. Negotiated Rate |
$3,596.58 |
| Rate for Payer: Cash Price |
$1,610.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,598.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,438.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,438.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,518.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,598.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,518.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,598.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,598.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,198.86
|
| Rate for Payer: Healthfirst Commercial |
$1,598.48
|
| Rate for Payer: Healthfirst Essential Plan |
$3,596.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,518.56
|
| Rate for Payer: Healthfirst QHP |
$1,598.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,118.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,598.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,358.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,118.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,598.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,198.86
|
| Rate for Payer: SOMOS Essential |
$1,198.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,598.48
|
|
|
PR ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH
|
Professional
|
Both
|
$5,983.60
|
|
|
Service Code
|
HCPCS 43331
|
| Min. Negotiated Rate |
$1,105.68 |
| Max. Negotiated Rate |
$3,553.99 |
| Rate for Payer: Cash Price |
$1,593.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,579.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,421.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,421.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,500.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,579.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,500.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,579.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,579.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,184.66
|
| Rate for Payer: Healthfirst Commercial |
$1,579.55
|
| Rate for Payer: Healthfirst Essential Plan |
$3,553.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,500.57
|
| Rate for Payer: Healthfirst QHP |
$1,579.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,105.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,579.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,342.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,105.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,579.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,184.66
|
| Rate for Payer: SOMOS Essential |
$1,184.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,579.55
|
|
|
PR ESOPHAGOSCOPY DILATE ESOPHAGUS BALLOON 30 MM
|
Professional
|
Both
|
$825.72
|
|
|
Service Code
|
HCPCS 43214
|
| Min. Negotiated Rate |
$156.44 |
| Max. Negotiated Rate |
$502.83 |
| Rate for Payer: Cash Price |
$223.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$223.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$212.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$223.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$212.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$223.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.61
|
| Rate for Payer: Healthfirst Commercial |
$223.48
|
| Rate for Payer: Healthfirst Essential Plan |
$502.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.31
|
| Rate for Payer: Healthfirst QHP |
$223.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$223.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$189.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$223.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$167.61
|
| Rate for Payer: SOMOS Essential |
$167.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$223.48
|
|
|
PR ESOPHAGOSCOPY FLEX BALLOON DILAT <30 MM DIAM
|
Professional
|
Both
|
$496.86
|
|
|
Service Code
|
HCPCS 43220
|
| Min. Negotiated Rate |
$94.31 |
| Max. Negotiated Rate |
$303.14 |
| Rate for Payer: Cash Price |
$134.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.05
|
| Rate for Payer: Healthfirst Commercial |
$134.73
|
| Rate for Payer: Healthfirst Essential Plan |
$303.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.99
|
| Rate for Payer: Healthfirst QHP |
$134.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.05
|
| Rate for Payer: SOMOS Essential |
$101.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.73
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE GUIDE WIRE DILATION
|
Professional
|
Both
|
$556.01
|
|
|
Service Code
|
HCPCS 43226
|
| Min. Negotiated Rate |
$105.51 |
| Max. Negotiated Rate |
$339.14 |
| Rate for Payer: Cash Price |
$150.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$143.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$143.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.05
|
| Rate for Payer: Healthfirst Commercial |
$150.73
|
| Rate for Payer: Healthfirst Essential Plan |
$339.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$143.19
|
| Rate for Payer: Healthfirst QHP |
$150.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$128.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$113.05
|
| Rate for Payer: SOMOS Essential |
$113.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.73
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$599.48
|
|
|
Service Code
|
HCPCS 43215
|
| Min. Negotiated Rate |
$113.48 |
| Max. Negotiated Rate |
$364.77 |
| Rate for Payer: Cash Price |
$162.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$162.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$145.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$145.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$154.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$162.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$154.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.59
|
| Rate for Payer: Healthfirst Commercial |
$162.12
|
| Rate for Payer: Healthfirst Essential Plan |
$364.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.01
|
| Rate for Payer: Healthfirst QHP |
$162.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$113.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$162.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$137.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$113.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$162.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.59
|
| Rate for Payer: SOMOS Essential |
$121.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$162.12
|
|
|
PR ESOPHAGOSCOPY FLEXIB LESION REMOVAL TUMOR SNARE
|
Professional
|
Both
|
$661.19
|
|
|
Service Code
|
HCPCS 43217
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$404.93 |
| Rate for Payer: Cash Price |
$181.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$179.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$161.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$179.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.98
|
| Rate for Payer: Healthfirst Commercial |
$179.97
|
| Rate for Payer: Healthfirst Essential Plan |
$404.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$170.97
|
| Rate for Payer: Healthfirst QHP |
$179.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$125.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$179.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$152.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$125.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$179.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$134.98
|
| Rate for Payer: SOMOS Essential |
$134.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.97
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSNASAL DIAGNOSTIC
|
Professional
|
Both
|
$351.05
|
|
|
Service Code
|
HCPCS 43197
|
| Min. Negotiated Rate |
$65.62 |
| Max. Negotiated Rate |
$210.94 |
| Rate for Payer: Cash Price |
$94.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$84.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$84.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$89.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$89.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.31
|
| Rate for Payer: Healthfirst Commercial |
$93.75
|
| Rate for Payer: Healthfirst Essential Plan |
$210.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$89.06
|
| Rate for Payer: Healthfirst QHP |
$93.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$70.31
|
| Rate for Payer: SOMOS Essential |
$70.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.75
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSNASAL WITH BIOPSY
|
Professional
|
Both
|
$418.53
|
|
|
Service Code
|
HCPCS 43198
|
| Min. Negotiated Rate |
$78.07 |
| Max. Negotiated Rate |
$250.94 |
| Rate for Payer: Cash Price |
$112.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.65
|
| Rate for Payer: Healthfirst Commercial |
$111.53
|
| Rate for Payer: Healthfirst Essential Plan |
$250.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.95
|
| Rate for Payer: Healthfirst QHP |
$111.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.65
|
| Rate for Payer: SOMOS Essential |
$83.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.53
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC
|
Professional
|
Both
|
$374.61
|
|
|
Service Code
|
HCPCS 43200
|
| Min. Negotiated Rate |
$70.23 |
| Max. Negotiated Rate |
$225.74 |
| Rate for Payer: Cash Price |
$101.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.25
|
| Rate for Payer: Healthfirst Commercial |
$100.33
|
| Rate for Payer: Healthfirst Essential Plan |
$225.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.31
|
| Rate for Payer: Healthfirst QHP |
$100.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.25
|
| Rate for Payer: SOMOS Essential |
$75.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.33
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL MUCOSAL RESEXN
|
Professional
|
Both
|
$976.36
|
|
|
Service Code
|
HCPCS 43211
|
| Min. Negotiated Rate |
$183.78 |
| Max. Negotiated Rate |
$590.72 |
| Rate for Payer: Cash Price |
$264.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$262.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$236.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$236.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$249.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$262.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$249.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$196.91
|
| Rate for Payer: Healthfirst Commercial |
$262.54
|
| Rate for Payer: Healthfirst Essential Plan |
$590.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.41
|
| Rate for Payer: Healthfirst QHP |
$262.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$183.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$262.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$223.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$183.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$262.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$196.91
|
| Rate for Payer: SOMOS Essential |
$196.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$262.54
|
|
