|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL ULTRASOUND EXAM
|
Professional
|
Both
|
$652.72
|
|
|
Service Code
|
HCPCS 43231
|
| Min. Negotiated Rate |
$121.37 |
| Max. Negotiated Rate |
$390.11 |
| Rate for Payer: Cash Price |
$177.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$173.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$173.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$173.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$173.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.03
|
| Rate for Payer: Healthfirst Commercial |
$173.38
|
| Rate for Payer: Healthfirst Essential Plan |
$390.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.71
|
| Rate for Payer: Healthfirst QHP |
$173.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$173.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$147.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$173.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.03
|
| Rate for Payer: SOMOS Essential |
$130.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$173.38
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$433.62
|
|
|
Service Code
|
HCPCS 43202
|
| Min. Negotiated Rate |
$81.43 |
| Max. Negotiated Rate |
$261.74 |
| Rate for Payer: Cash Price |
$117.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.25
|
| Rate for Payer: Healthfirst Commercial |
$116.33
|
| Rate for Payer: Healthfirst Essential Plan |
$261.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.51
|
| Rate for Payer: Healthfirst QHP |
$116.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.25
|
| Rate for Payer: SOMOS Essential |
$87.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.33
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE TRANSORAL W SUBMUCOUS INJ
|
Professional
|
Both
|
$439.08
|
|
|
Service Code
|
HCPCS 43201
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$264.87 |
| Rate for Payer: Cash Price |
$119.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.29
|
| Rate for Payer: Healthfirst Commercial |
$117.72
|
| Rate for Payer: Healthfirst Essential Plan |
$264.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.83
|
| Rate for Payer: Healthfirst QHP |
$117.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.29
|
| Rate for Payer: SOMOS Essential |
$88.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.72
|
|
|
PR ESOPHAGOSCOPY FLEXIBLE W/BLEEDING CONTROL
|
Professional
|
Both
|
$689.05
|
|
|
Service Code
|
HCPCS 43227
|
| Min. Negotiated Rate |
$129.83 |
| Max. Negotiated Rate |
$417.31 |
| Rate for Payer: Cash Price |
$187.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.10
|
| Rate for Payer: Healthfirst Commercial |
$185.47
|
| Rate for Payer: Healthfirst Essential Plan |
$417.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.20
|
| Rate for Payer: Healthfirst QHP |
$185.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.10
|
| Rate for Payer: SOMOS Essential |
$139.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.47
|
|
|
PR ESOPHAGOSCOPY FLEX TRANSORAL INJECTION VARICES
|
Professional
|
Both
|
$562.63
|
|
|
Service Code
|
HCPCS 43204
|
| Min. Negotiated Rate |
$106.61 |
| Max. Negotiated Rate |
$342.68 |
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$137.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$137.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$144.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$144.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.22
|
| Rate for Payer: Healthfirst Commercial |
$152.30
|
| Rate for Payer: Healthfirst Essential Plan |
$342.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$144.69
|
| Rate for Payer: Healthfirst QHP |
$152.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$152.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$129.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$106.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$114.22
|
| Rate for Payer: SOMOS Essential |
$114.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.30
|
|
|
PR ESOPHAGOSCOPY FLEX TRANSORAL LESION ABLATION
|
Professional
|
Both
|
$820.72
|
|
|
Service Code
|
HCPCS 43229
|
| Min. Negotiated Rate |
$154.55 |
| Max. Negotiated Rate |
$496.78 |
| Rate for Payer: Cash Price |
$223.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$220.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$198.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$198.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$209.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$209.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.59
|
| Rate for Payer: Healthfirst Commercial |
$220.79
|
| Rate for Payer: Healthfirst Essential Plan |
$496.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.75
|
| Rate for Payer: Healthfirst QHP |
$220.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$220.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$220.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.59
|
| Rate for Payer: SOMOS Essential |
$165.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$220.79
|
|
|
PR ESOPHAGOSCOPY INTRA/TRANSMURAL NEEDLE ASPIRAT/BX
|
Professional
|
Both
|
$815.26
|
|
|
Service Code
|
HCPCS 43232
|
| Min. Negotiated Rate |
$154.53 |
| Max. Negotiated Rate |
$496.69 |
| Rate for Payer: Cash Price |
$224.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$220.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$198.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$198.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$209.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$209.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.56
|
| Rate for Payer: Healthfirst Commercial |
$220.75
|
| Rate for Payer: Healthfirst Essential Plan |
$496.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.71
|
| Rate for Payer: Healthfirst QHP |
$220.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$220.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$220.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.56
|
| Rate for Payer: SOMOS Essential |
$165.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$220.75
|
|
|
PR ESOPHAGOSCOPY RETROGRADE DILATE BALLOON/OTHER
|
Professional
|
Both
|
$1,110.27
|
|
|
Service Code
|
HCPCS 43213
|
| Min. Negotiated Rate |
$205.90 |
| Max. Negotiated Rate |
$661.82 |
| Rate for Payer: Cash Price |
$298.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$294.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$264.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$264.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$279.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$294.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$279.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$294.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$294.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$220.60
|
| Rate for Payer: Healthfirst Commercial |
$294.14
|
| Rate for Payer: Healthfirst Essential Plan |
$661.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$279.43
|
| Rate for Payer: Healthfirst QHP |
$294.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$205.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$294.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$250.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$205.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$294.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$220.60
|
| Rate for Payer: SOMOS Essential |
$220.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$294.14
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL BALLOON DILATION
|
Professional
|
Both
|
$792.40
|
|
|
Service Code
|
HCPCS 43195
|
| Min. Negotiated Rate |
$150.07 |
| Max. Negotiated Rate |
$482.36 |
| Rate for Payer: Cash Price |
$214.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$214.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$192.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$203.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$214.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$203.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$214.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$214.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.78
|
| Rate for Payer: Healthfirst Commercial |
$214.38
|
| Rate for Payer: Healthfirst Essential Plan |
$482.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$203.66
|
| Rate for Payer: Healthfirst QHP |
$214.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$150.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$214.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$182.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$150.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$214.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$160.78
|
| Rate for Payer: SOMOS Essential |
$160.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$214.38
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL DIAGNOSTIC BRUSH
|
Professional
|
Both
|
$667.56
|
|
|
Service Code
|
HCPCS 43191
|
| Min. Negotiated Rate |
$126.37 |
| Max. Negotiated Rate |
$406.19 |
| Rate for Payer: Cash Price |
$180.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.40
|
| Rate for Payer: Healthfirst Commercial |
$180.53
|
| Rate for Payer: Healthfirst Essential Plan |
$406.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$171.50
|
| Rate for Payer: Healthfirst QHP |
$180.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$180.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.40
|
| Rate for Payer: SOMOS Essential |
$135.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.53
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL INJ SUBMUCOSAL
|
Professional
|
Both
|
$729.02
|
|
|
Service Code
|
HCPCS 43192
|
| Min. Negotiated Rate |
$136.75 |
| Max. Negotiated Rate |
$439.56 |
| Rate for Payer: Cash Price |
$197.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$195.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$175.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$195.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.52
|
| Rate for Payer: Healthfirst Commercial |
$195.36
|
| Rate for Payer: Healthfirst Essential Plan |
$439.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.59
|
| Rate for Payer: Healthfirst QHP |
$195.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$195.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$195.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.52
|
| Rate for Payer: SOMOS Essential |
$146.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.36
|
|
|
PR ESOPHAGOSCOPY RIGID TRANSORAL WITH BIOPSY
|
Professional
|
Both
|
$724.82
|
|
|
Service Code
|
HCPCS 43193
|
| Min. Negotiated Rate |
$137.35 |
| Max. Negotiated Rate |
$441.47 |
| Rate for Payer: Cash Price |
$196.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$196.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$176.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$176.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$196.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.16
|
| Rate for Payer: Healthfirst Commercial |
$196.21
|
| Rate for Payer: Healthfirst Essential Plan |
$441.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$186.40
|
| Rate for Payer: Healthfirst QHP |
$196.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$137.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$196.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$166.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$137.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$196.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$147.16
|
| Rate for Payer: SOMOS Essential |
$147.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$196.21
|
|
|
PR ESOPHAGOSCOPY RIG TRANSORAL GUIDE WIRE DILATION
|
Professional
|
Both
|
$831.08
|
|
|
Service Code
|
HCPCS 43196
|
| Min. Negotiated Rate |
$158.03 |
| Max. Negotiated Rate |
$507.96 |
| Rate for Payer: Cash Price |
$226.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$225.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$214.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$225.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$214.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.32
|
| Rate for Payer: Healthfirst Commercial |
$225.76
|
| Rate for Payer: Healthfirst Essential Plan |
$507.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$214.47
|
| Rate for Payer: Healthfirst QHP |
$225.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$225.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$191.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$225.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.32
|
| Rate for Payer: SOMOS Essential |
$169.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$225.76
|
|
|
PR ESOPHAGOSCOPY RIG TRANSORAL REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$832.62
|
|
|
Service Code
|
HCPCS 43194
|
| Min. Negotiated Rate |
$154.53 |
| Max. Negotiated Rate |
$496.71 |
| Rate for Payer: Cash Price |
$220.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$220.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$198.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$198.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$209.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$209.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$220.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$220.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.57
|
| Rate for Payer: Healthfirst Commercial |
$220.76
|
| Rate for Payer: Healthfirst Essential Plan |
$496.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.72
|
| Rate for Payer: Healthfirst QHP |
$220.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$220.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$187.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$220.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$165.57
|
| Rate for Payer: SOMOS Essential |
$165.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$220.76
|
|
|
PR ESOPHAGOSCOPY TRANSORAL STENT PLACEMENT
|
Professional
|
Both
|
$814.56
|
|
|
Service Code
|
HCPCS 43212
|
| Min. Negotiated Rate |
$151.91 |
| Max. Negotiated Rate |
$488.30 |
| Rate for Payer: Cash Price |
$217.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$217.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$195.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$217.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.76
|
| Rate for Payer: Healthfirst Commercial |
$217.02
|
| Rate for Payer: Healthfirst Essential Plan |
$488.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.17
|
| Rate for Payer: Healthfirst QHP |
$217.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$151.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$217.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$184.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$151.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$217.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.76
|
| Rate for Payer: SOMOS Essential |
$162.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$217.02
|
|
|
PR ESOPHAGOSCOPY TRANSORAL W/OPTICAL ENDOMICROSCOPY
|
Professional
|
Both
|
$552.02
|
|
|
Service Code
|
HCPCS 43206
|
| Min. Negotiated Rate |
$104.94 |
| Max. Negotiated Rate |
$337.32 |
| Rate for Payer: Cash Price |
$149.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$149.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$149.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.44
|
| Rate for Payer: Healthfirst Commercial |
$149.92
|
| Rate for Payer: Healthfirst Essential Plan |
$337.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.42
|
| Rate for Payer: Healthfirst QHP |
$149.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$149.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.44
|
| Rate for Payer: SOMOS Essential |
$112.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.92
|
|
|
PR ESOPHAGOSCP RIG TRANSORAL HYPOPHARYNX CRV ESOPH
|
Professional
|
Both
|
$2,357.53
|
|
|
Service Code
|
HCPCS 43180
|
| Min. Negotiated Rate |
$443.65 |
| Max. Negotiated Rate |
$1,426.03 |
| Rate for Payer: Cash Price |
$637.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$633.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$570.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$570.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$602.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$633.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$602.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$633.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$633.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$475.34
|
| Rate for Payer: Healthfirst Commercial |
$633.79
|
| Rate for Payer: Healthfirst Essential Plan |
$1,426.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$602.10
|
| Rate for Payer: Healthfirst QHP |
$633.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$443.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$633.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$538.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$443.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$633.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$475.34
|
| Rate for Payer: SOMOS Essential |
$475.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$633.79
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR
|
Professional
|
Both
|
$4,769.98
|
|
|
Service Code
|
HCPCS 43352
|
| Min. Negotiated Rate |
$883.60 |
| Max. Negotiated Rate |
$2,840.13 |
| Rate for Payer: Cash Price |
$1,272.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,262.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,136.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,136.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,199.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,262.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,199.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,262.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,262.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$946.71
|
| Rate for Payer: Healthfirst Commercial |
$1,262.28
|
| Rate for Payer: Healthfirst Essential Plan |
$2,840.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,199.17
|
| Rate for Payer: Healthfirst QHP |
$1,262.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$883.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,262.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,072.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$883.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,262.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$946.71
|
| Rate for Payer: SOMOS Essential |
$946.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,262.28
|
|
|
PR ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR
|
Professional
|
Both
|
$5,883.85
|
|
|
Service Code
|
HCPCS 43351
|
| Min. Negotiated Rate |
$1,091.16 |
| Max. Negotiated Rate |
$3,507.30 |
| Rate for Payer: Cash Price |
$1,572.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,558.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,402.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,402.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,480.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,558.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,480.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,558.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,558.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,169.10
|
| Rate for Payer: Healthfirst Commercial |
$1,558.80
|
| Rate for Payer: Healthfirst Essential Plan |
$3,507.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,480.86
|
| Rate for Payer: Healthfirst QHP |
$1,558.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,091.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,558.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,324.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,091.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,558.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,169.10
|
| Rate for Payer: SOMOS Essential |
$1,169.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,558.80
|
|
|
PR ESOPHAGOTOMY CERVICAL APPR W/RMVL FB
|
Professional
|
Both
|
$2,555.98
|
|
|
Service Code
|
HCPCS 43020
|
| Min. Negotiated Rate |
$477.24 |
| Max. Negotiated Rate |
$1,533.98 |
| Rate for Payer: Cash Price |
$685.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$681.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$613.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$613.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$647.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$681.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$647.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$681.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$681.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$511.33
|
| Rate for Payer: Healthfirst Commercial |
$681.77
|
| Rate for Payer: Healthfirst Essential Plan |
$1,533.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$647.68
|
| Rate for Payer: Healthfirst QHP |
$681.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$477.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$681.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$579.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$477.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$681.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$511.33
|
| Rate for Payer: SOMOS Essential |
$511.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$681.77
|
|
|
PR ESOPHAGOTOMY THORACIC APPR W/RMVL FB
|
Professional
|
Both
|
$5,821.13
|
|
|
Service Code
|
HCPCS 43045
|
| Min. Negotiated Rate |
$1,077.99 |
| Max. Negotiated Rate |
$3,464.98 |
| Rate for Payer: Cash Price |
$1,553.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,539.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,385.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,385.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,462.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,539.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,462.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,539.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,539.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,154.99
|
| Rate for Payer: Healthfirst Commercial |
$1,539.99
|
| Rate for Payer: Healthfirst Essential Plan |
$3,464.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,462.99
|
| Rate for Payer: Healthfirst QHP |
$1,539.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,077.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,539.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,308.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,077.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,539.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,154.99
|
| Rate for Payer: SOMOS Essential |
$1,154.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,539.99
|
|
|
PR ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS
|
Professional
|
Both
|
$182.42
|
|
|
Service Code
|
HCPCS 91030 26
|
| Min. Negotiated Rate |
$34.38 |
| Max. Negotiated Rate |
$110.52 |
| Rate for Payer: Amida Care Medicaid |
$108.07
|
| Rate for Payer: Cash Price |
$49.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.84
|
| Rate for Payer: Healthfirst Commercial |
$49.12
|
| Rate for Payer: Healthfirst Essential Plan |
$110.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.66
|
| Rate for Payer: Healthfirst QHP |
$49.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.84
|
| Rate for Payer: SOMOS Essential |
$36.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.12
|
|
|
PR ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS
|
Professional
|
Both
|
$429.52
|
|
|
Service Code
|
HCPCS 91030 TC
|
| Min. Negotiated Rate |
$80.48 |
| Max. Negotiated Rate |
$258.68 |
| Rate for Payer: Amida Care Medicaid |
$108.07
|
| Rate for Payer: Cash Price |
$118.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$114.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$114.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.23
|
| Rate for Payer: Healthfirst Commercial |
$114.97
|
| Rate for Payer: Healthfirst Essential Plan |
$258.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.22
|
| Rate for Payer: Healthfirst QHP |
$114.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$114.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$114.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.23
|
| Rate for Payer: SOMOS Essential |
$86.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.97
|
|
|
PR ESOPHAGUS ACID PERFUSION TEST ESOPHAGITIS
|
Professional
|
Both
|
$611.94
|
|
|
Service Code
|
HCPCS 91030
|
| Min. Negotiated Rate |
$108.07 |
| Max. Negotiated Rate |
$369.18 |
| Rate for Payer: Amida Care Medicaid |
$108.07
|
| Rate for Payer: Cash Price |
$168.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$164.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$155.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$164.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$164.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$164.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.06
|
| Rate for Payer: Healthfirst Commercial |
$164.08
|
| Rate for Payer: Healthfirst Essential Plan |
$369.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.88
|
| Rate for Payer: Healthfirst QHP |
$164.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$164.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$139.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$164.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.06
|
| Rate for Payer: SOMOS Essential |
$123.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$164.08
|
|
|
PR ESOPHAGUS LENGTHENING
|
Professional
|
Both
|
$513.66
|
|
|
Service Code
|
HCPCS 43338
|
| Min. Negotiated Rate |
$93.51 |
| Max. Negotiated Rate |
$300.56 |
| Rate for Payer: Cash Price |
$134.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$133.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$133.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.19
|
| Rate for Payer: Healthfirst Commercial |
$133.58
|
| Rate for Payer: Healthfirst Essential Plan |
$300.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.90
|
| Rate for Payer: Healthfirst QHP |
$133.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$133.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$133.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.19
|
| Rate for Payer: SOMOS Essential |
$100.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.58
|
|
