|
PR GASTRIC INTUBATION DX & ASPIRATJ MULTIPLE SPEC
|
Professional
|
Both
|
$249.90
|
|
|
Service Code
|
HCPCS 43755
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$154.17 |
| Rate for Payer: Cash Price |
$68.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.39
|
| Rate for Payer: Healthfirst Commercial |
$68.52
|
| Rate for Payer: Healthfirst Essential Plan |
$154.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.09
|
| Rate for Payer: Healthfirst QHP |
$68.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.39
|
| Rate for Payer: SOMOS Essential |
$51.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.52
|
|
|
PR GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE
|
Professional
|
Both
|
$94.08
|
|
|
Service Code
|
HCPCS 43753
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.37
|
| Rate for Payer: Healthfirst Commercial |
$24.49
|
| Rate for Payer: Healthfirst Essential Plan |
$55.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.27
|
| Rate for Payer: Healthfirst QHP |
$24.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.37
|
| Rate for Payer: SOMOS Essential |
$18.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.49
|
|
|
PR GASTRIC MOTILITY MANOMETRIC STUDIES
|
Professional
|
Both
|
$283.29
|
|
|
Service Code
|
HCPCS 91020 26
|
| Min. Negotiated Rate |
$53.84 |
| Max. Negotiated Rate |
$185.95 |
| Rate for Payer: Amida Care Medicaid |
$185.95
|
| Rate for Payer: Cash Price |
$78.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.69
|
| Rate for Payer: Healthfirst Commercial |
$76.92
|
| Rate for Payer: Healthfirst Essential Plan |
$173.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.07
|
| Rate for Payer: Healthfirst QHP |
$76.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.69
|
| Rate for Payer: SOMOS Essential |
$57.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.92
|
|
|
PR GASTRIC MOTILITY MANOMETRIC STUDIES
|
Professional
|
Both
|
$880.92
|
|
|
Service Code
|
HCPCS 91020 TC
|
| Min. Negotiated Rate |
$162.15 |
| Max. Negotiated Rate |
$521.19 |
| Rate for Payer: Amida Care Medicaid |
$185.95
|
| Rate for Payer: Cash Price |
$242.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$208.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$231.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.73
|
| Rate for Payer: Healthfirst Commercial |
$231.64
|
| Rate for Payer: Healthfirst Essential Plan |
$521.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$220.06
|
| Rate for Payer: Healthfirst QHP |
$231.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$162.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$196.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$162.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$173.73
|
| Rate for Payer: SOMOS Essential |
$173.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.64
|
|
|
PR GASTRIC MOTILITY MANOMETRIC STUDIES
|
Professional
|
Both
|
$1,164.21
|
|
|
Service Code
|
HCPCS 91020
|
| Min. Negotiated Rate |
$185.95 |
| Max. Negotiated Rate |
$694.28 |
| Rate for Payer: Amida Care Medicaid |
$185.95
|
| Rate for Payer: Cash Price |
$321.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$308.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$277.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$277.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$293.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$308.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$293.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$308.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$231.43
|
| Rate for Payer: Healthfirst Commercial |
$308.57
|
| Rate for Payer: Healthfirst Essential Plan |
$694.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$293.14
|
| Rate for Payer: Healthfirst QHP |
$308.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$216.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$308.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$262.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$216.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$308.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$231.43
|
| Rate for Payer: SOMOS Essential |
$231.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$308.57
|
|
|
PR GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/<
|
Professional
|
Both
|
$7,480.41
|
|
|
Service Code
|
HCPCS 43846
|
| Min. Negotiated Rate |
$1,383.06 |
| Max. Negotiated Rate |
$4,445.55 |
| Rate for Payer: Cash Price |
$1,991.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,975.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,778.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,778.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,877.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,975.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,877.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,975.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,975.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,481.85
|
| Rate for Payer: Healthfirst Commercial |
$1,975.80
|
| Rate for Payer: Healthfirst Essential Plan |
$4,445.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,877.01
|
| Rate for Payer: Healthfirst QHP |
$1,975.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,383.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,975.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,679.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,383.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,975.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,481.85
|
| Rate for Payer: SOMOS Essential |
$1,481.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,975.80
|
|
|
PR GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ
|
Professional
|
Both
|
$8,186.50
|
|
|
Service Code
|
HCPCS 43847
|
| Min. Negotiated Rate |
$1,512.93 |
| Max. Negotiated Rate |
$4,862.99 |
| Rate for Payer: Cash Price |
$2,179.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,161.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,945.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,945.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,053.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,161.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,053.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,161.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,161.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,621.00
|
| Rate for Payer: Healthfirst Commercial |
$2,161.33
|
| Rate for Payer: Healthfirst Essential Plan |
$4,862.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,053.26
|
| Rate for Payer: Healthfirst QHP |
$2,161.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,512.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,161.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,837.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,512.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,161.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,621.00
|
| Rate for Payer: SOMOS Essential |
$1,621.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,161.33
|
|
|
PR GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM
|
Professional
|
Both
|
$8,848.25
|
|
|
Service Code
|
HCPCS 43845
|
| Min. Negotiated Rate |
$1,640.51 |
| Max. Negotiated Rate |
$5,273.06 |
| Rate for Payer: Cash Price |
$2,358.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,343.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,109.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,109.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,226.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,343.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,226.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,343.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,343.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,757.68
|
| Rate for Payer: Healthfirst Commercial |
$2,343.58
|
| Rate for Payer: Healthfirst Essential Plan |
$5,273.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,226.40
|
| Rate for Payer: Healthfirst QHP |
$2,343.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,640.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,343.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,992.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,640.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,343.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,757.68
|
| Rate for Payer: SOMOS Essential |
$1,757.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,343.58
|
|
|
PR GASTROCNEMIUS RECESSION
|
Professional
|
Both
|
$1,958.88
|
|
|
Service Code
|
HCPCS 27687
|
| Min. Negotiated Rate |
$373.71 |
| Max. Negotiated Rate |
$1,201.21 |
| Rate for Payer: Cash Price |
$536.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$533.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$480.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$480.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$507.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$533.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$507.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$533.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$533.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$400.40
|
| Rate for Payer: Healthfirst Commercial |
$533.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,201.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$507.18
|
| Rate for Payer: Healthfirst QHP |
$533.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$373.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$533.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$453.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$373.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$533.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$400.40
|
| Rate for Payer: SOMOS Essential |
$400.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$533.87
|
|
|
PR GASTRODUODENOSTOMY
|
Professional
|
Both
|
$4,604.29
|
|
|
Service Code
|
HCPCS 43810
|
| Min. Negotiated Rate |
$853.30 |
| Max. Negotiated Rate |
$2,742.75 |
| Rate for Payer: Cash Price |
$1,227.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,219.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,097.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,097.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,158.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,219.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,158.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,219.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,219.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$914.25
|
| Rate for Payer: Healthfirst Commercial |
$1,219.00
|
| Rate for Payer: Healthfirst Essential Plan |
$2,742.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,158.05
|
| Rate for Payer: Healthfirst QHP |
$1,219.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$853.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,219.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,036.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$853.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,219.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$914.25
|
| Rate for Payer: SOMOS Essential |
$914.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,219.00
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$199.71
|
|
|
Service Code
|
HCPCS 91034 26
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$159.19 |
| Rate for Payer: Amida Care Medicaid |
$159.19
|
| Rate for Payer: Cash Price |
$54.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.90
|
| Rate for Payer: Healthfirst Commercial |
$53.20
|
| Rate for Payer: Healthfirst Essential Plan |
$119.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.54
|
| Rate for Payer: Healthfirst QHP |
$53.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.90
|
| Rate for Payer: SOMOS Essential |
$39.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.20
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$622.16
|
|
|
Service Code
|
HCPCS 91034 TC
|
| Min. Negotiated Rate |
$113.08 |
| Max. Negotiated Rate |
$363.49 |
| Rate for Payer: Amida Care Medicaid |
$159.19
|
| Rate for Payer: Cash Price |
$168.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$161.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$145.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$145.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$153.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$161.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$153.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.16
|
| Rate for Payer: Healthfirst Commercial |
$161.55
|
| Rate for Payer: Healthfirst Essential Plan |
$363.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.47
|
| Rate for Payer: Healthfirst QHP |
$161.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$113.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$161.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$137.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$113.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$161.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.16
|
| Rate for Payer: SOMOS Essential |
$121.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.55
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$821.87
|
|
|
Service Code
|
HCPCS 91034
|
| Min. Negotiated Rate |
$150.32 |
| Max. Negotiated Rate |
$483.17 |
| Rate for Payer: Amida Care Medicaid |
$159.19
|
| Rate for Payer: Cash Price |
$223.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$214.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$193.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$193.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$204.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$214.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$204.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$214.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$214.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.06
|
| Rate for Payer: Healthfirst Commercial |
$214.74
|
| Rate for Payer: Healthfirst Essential Plan |
$483.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$204.00
|
| Rate for Payer: Healthfirst QHP |
$214.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$150.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$214.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$182.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$150.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$214.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$161.06
|
| Rate for Payer: SOMOS Essential |
$161.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$214.74
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$522.97
|
|
|
Service Code
|
HCPCS 91037 TC
|
| Min. Negotiated Rate |
$95.69 |
| Max. Negotiated Rate |
$307.57 |
| Rate for Payer: Amida Care Medicaid |
$127.70
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.53
|
| Rate for Payer: Healthfirst Commercial |
$136.70
|
| Rate for Payer: Healthfirst Essential Plan |
$307.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.87
|
| Rate for Payer: Healthfirst QHP |
$136.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.53
|
| Rate for Payer: SOMOS Essential |
$102.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.70
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$715.79
|
|
|
Service Code
|
HCPCS 91037
|
| Min. Negotiated Rate |
$127.70 |
| Max. Negotiated Rate |
$425.88 |
| Rate for Payer: Amida Care Medicaid |
$127.70
|
| Rate for Payer: Cash Price |
$195.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$189.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$170.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$170.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$179.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$189.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$179.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.96
|
| Rate for Payer: Healthfirst Commercial |
$189.28
|
| Rate for Payer: Healthfirst Essential Plan |
$425.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$179.82
|
| Rate for Payer: Healthfirst QHP |
$189.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$132.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$189.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$160.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$132.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$189.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.96
|
| Rate for Payer: SOMOS Essential |
$141.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.28
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$192.82
|
|
|
Service Code
|
HCPCS 91037 26
|
| Min. Negotiated Rate |
$36.81 |
| Max. Negotiated Rate |
$127.70 |
| Rate for Payer: Amida Care Medicaid |
$127.70
|
| Rate for Payer: Cash Price |
$52.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.44
|
| Rate for Payer: Healthfirst Commercial |
$52.58
|
| Rate for Payer: Healthfirst Essential Plan |
$118.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.95
|
| Rate for Payer: Healthfirst QHP |
$52.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.44
|
| Rate for Payer: SOMOS Essential |
$39.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.58
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$1,979.85
|
|
|
Service Code
|
HCPCS 91035
|
| Min. Negotiated Rate |
$353.77 |
| Max. Negotiated Rate |
$1,137.11 |
| Rate for Payer: Amida Care Medicaid |
$393.07
|
| Rate for Payer: Cash Price |
$532.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$505.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$454.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$454.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$480.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$505.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$480.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$505.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$505.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$379.04
|
| Rate for Payer: Healthfirst Commercial |
$505.38
|
| Rate for Payer: Healthfirst Essential Plan |
$1,137.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$480.11
|
| Rate for Payer: Healthfirst QHP |
$505.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$353.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$505.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$429.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$353.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$505.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$379.04
|
| Rate for Payer: SOMOS Essential |
$379.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$505.38
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$329.74
|
|
|
Service Code
|
HCPCS 91035 26
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$393.07 |
| Rate for Payer: Amida Care Medicaid |
$393.07
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$89.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$89.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$89.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.90
|
| Rate for Payer: Healthfirst Commercial |
$89.20
|
| Rate for Payer: Healthfirst Essential Plan |
$200.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$84.74
|
| Rate for Payer: Healthfirst QHP |
$89.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$62.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$89.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$62.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$89.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.90
|
| Rate for Payer: SOMOS Essential |
$66.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$89.20
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$1,650.11
|
|
|
Service Code
|
HCPCS 91035 TC
|
| Min. Negotiated Rate |
$291.33 |
| Max. Negotiated Rate |
$936.40 |
| Rate for Payer: Amida Care Medicaid |
$393.07
|
| Rate for Payer: Cash Price |
$442.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$416.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$374.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$374.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$395.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$416.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$395.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$416.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$416.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$312.13
|
| Rate for Payer: Healthfirst Commercial |
$416.18
|
| Rate for Payer: Healthfirst Essential Plan |
$936.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$395.37
|
| Rate for Payer: Healthfirst QHP |
$416.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$291.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$416.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$353.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$291.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$416.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$312.13
|
| Rate for Payer: SOMOS Essential |
$312.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$416.18
|
|
|
PR GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R
|
Professional
|
Both
|
$3,682.77
|
|
|
Service Code
|
HCPCS 91111
|
| Min. Negotiated Rate |
$556.11 |
| Max. Negotiated Rate |
$2,164.03 |
| Rate for Payer: Amida Care Medicaid |
$556.11
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$961.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$865.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$913.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$961.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$913.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$961.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$961.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$721.34
|
| Rate for Payer: Healthfirst Commercial |
$961.79
|
| Rate for Payer: Healthfirst Essential Plan |
$2,164.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$913.70
|
| Rate for Payer: Healthfirst QHP |
$961.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$673.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$961.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$817.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$673.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$961.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$721.34
|
| Rate for Payer: SOMOS Essential |
$721.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$961.79
|
|
|
PR GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R
|
Professional
|
Both
|
$179.73
|
|
|
Service Code
|
HCPCS 91111 26
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$556.11 |
| Rate for Payer: Amida Care Medicaid |
$556.11
|
| Rate for Payer: Cash Price |
$48.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.28
|
| Rate for Payer: Healthfirst Commercial |
$48.38
|
| Rate for Payer: Healthfirst Essential Plan |
$108.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.96
|
| Rate for Payer: Healthfirst QHP |
$48.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.28
|
| Rate for Payer: SOMOS Essential |
$36.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.38
|
|
|
PR GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R
|
Professional
|
Both
|
$3,503.05
|
|
|
Service Code
|
HCPCS 91111 TC
|
| Min. Negotiated Rate |
$556.11 |
| Max. Negotiated Rate |
$2,055.17 |
| Rate for Payer: Amida Care Medicaid |
$556.11
|
| Rate for Payer: Cash Price |
$979.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$913.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$822.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$822.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$867.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$913.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$867.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$913.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$913.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$685.06
|
| Rate for Payer: Healthfirst Commercial |
$913.41
|
| Rate for Payer: Healthfirst Essential Plan |
$2,055.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$867.74
|
| Rate for Payer: Healthfirst QHP |
$913.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$639.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$913.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$776.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$639.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$913.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$685.06
|
| Rate for Payer: SOMOS Essential |
$685.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$913.41
|
|
|
PR GASTROJEJUNOSTOMY W/O VAGOTOMY
|
Professional
|
Both
|
$6,057.03
|
|
|
Service Code
|
HCPCS 43820
|
| Min. Negotiated Rate |
$1,123.30 |
| Max. Negotiated Rate |
$3,610.62 |
| Rate for Payer: Cash Price |
$1,617.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,604.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,444.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,444.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,524.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,604.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,524.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,604.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,604.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,203.54
|
| Rate for Payer: Healthfirst Commercial |
$1,604.72
|
| Rate for Payer: Healthfirst Essential Plan |
$3,610.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,524.48
|
| Rate for Payer: Healthfirst QHP |
$1,604.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,123.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,604.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,364.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,123.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,604.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,203.54
|
| Rate for Payer: SOMOS Essential |
$1,203.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,604.72
|
|
|
PR GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE
|
Professional
|
Both
|
$5,940.03
|
|
|
Service Code
|
HCPCS 43825
|
| Min. Negotiated Rate |
$1,099.51 |
| Max. Negotiated Rate |
$3,534.14 |
| Rate for Payer: Cash Price |
$1,582.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,570.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,413.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,413.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,492.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,570.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,492.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,570.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,570.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,178.05
|
| Rate for Payer: Healthfirst Commercial |
$1,570.73
|
| Rate for Payer: Healthfirst Essential Plan |
$3,534.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,492.19
|
| Rate for Payer: Healthfirst QHP |
$1,570.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,099.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,570.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,335.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,099.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,570.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,178.05
|
| Rate for Payer: SOMOS Essential |
$1,178.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,570.73
|
|
|
PR GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$6,130.71
|
|
|
Service Code
|
HCPCS 43840
|
| Min. Negotiated Rate |
$1,135.63 |
| Max. Negotiated Rate |
$3,650.24 |
| Rate for Payer: Cash Price |
$1,634.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,622.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,460.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,460.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,541.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,622.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,541.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,622.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,622.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,216.75
|
| Rate for Payer: Healthfirst Commercial |
$1,622.33
|
| Rate for Payer: Healthfirst Essential Plan |
$3,650.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,541.21
|
| Rate for Payer: Healthfirst QHP |
$1,622.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,135.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,622.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,378.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,135.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,622.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,216.75
|
| Rate for Payer: SOMOS Essential |
$1,216.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,622.33
|
|
