|
PR GASTROSTOMY OPN NEONATAL FEEDING
|
Professional
|
Both
|
$2,754.47
|
|
|
Service Code
|
HCPCS 43831
|
| Min. Negotiated Rate |
$512.41 |
| Max. Negotiated Rate |
$1,647.05 |
| Rate for Payer: Cash Price |
$738.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$732.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$658.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$658.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$695.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$732.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$695.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$732.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$732.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$549.01
|
| Rate for Payer: Healthfirst Commercial |
$732.02
|
| Rate for Payer: Healthfirst Essential Plan |
$1,647.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$695.42
|
| Rate for Payer: Healthfirst QHP |
$732.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$512.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$732.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$622.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$512.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$732.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$549.01
|
| Rate for Payer: SOMOS Essential |
$549.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$732.02
|
|
|
PR GASTROSTOMY OPN W/CONSTJ GSTR TUBE
|
Professional
|
Both
|
$4,702.71
|
|
|
Service Code
|
HCPCS 43832
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$2,812.50 |
| Rate for Payer: Cash Price |
$1,261.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,125.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,125.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,187.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,250.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,187.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$937.50
|
| Rate for Payer: Healthfirst Commercial |
$1,250.00
|
| Rate for Payer: Healthfirst Essential Plan |
$2,812.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,187.50
|
| Rate for Payer: Healthfirst QHP |
$1,250.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$875.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,250.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,062.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$875.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,250.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$937.50
|
| Rate for Payer: SOMOS Essential |
$937.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,250.00
|
|
|
PR GASTROSTOMY OPN W/O CONSTJ GSTR TUBE SPX
|
Professional
|
Both
|
$3,169.74
|
|
|
Service Code
|
HCPCS 43830
|
| Min. Negotiated Rate |
$587.80 |
| Max. Negotiated Rate |
$1,889.37 |
| Rate for Payer: Cash Price |
$846.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$839.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$755.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$755.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$797.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$839.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$797.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$839.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$839.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$629.79
|
| Rate for Payer: Healthfirst Commercial |
$839.72
|
| Rate for Payer: Healthfirst Essential Plan |
$1,889.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$797.73
|
| Rate for Payer: Healthfirst QHP |
$839.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$587.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$839.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$713.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$587.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$839.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$629.79
|
| Rate for Payer: SOMOS Essential |
$629.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$839.72
|
|
|
PR GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$3,519.74
|
|
|
Service Code
|
HCPCS 43500
|
| Min. Negotiated Rate |
$659.92 |
| Max. Negotiated Rate |
$2,121.16 |
| Rate for Payer: Cash Price |
$948.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$942.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$848.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$848.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$895.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$942.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$895.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$942.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$942.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$707.05
|
| Rate for Payer: Healthfirst Commercial |
$942.74
|
| Rate for Payer: Healthfirst Essential Plan |
$2,121.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.60
|
| Rate for Payer: Healthfirst QHP |
$942.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$659.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$942.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$801.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$659.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$942.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$707.05
|
| Rate for Payer: SOMOS Essential |
$707.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$942.74
|
|
|
PR GASTROTOMY W/SUTR RPR PRE-ESOPG/GASTRIC LAC
|
Professional
|
Both
|
$6,911.59
|
|
|
Service Code
|
HCPCS 43502
|
| Min. Negotiated Rate |
$1,276.62 |
| Max. Negotiated Rate |
$4,103.44 |
| Rate for Payer: Cash Price |
$1,839.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,823.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,641.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,641.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,732.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,823.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,732.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,823.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,823.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,367.81
|
| Rate for Payer: Healthfirst Commercial |
$1,823.75
|
| Rate for Payer: Healthfirst Essential Plan |
$4,103.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,732.56
|
| Rate for Payer: Healthfirst QHP |
$1,823.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,276.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,823.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,550.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,276.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,823.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,367.81
|
| Rate for Payer: SOMOS Essential |
$1,367.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,823.75
|
|
|
PR GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER
|
Professional
|
Both
|
$6,080.06
|
|
|
Service Code
|
HCPCS 43501
|
| Min. Negotiated Rate |
$1,122.82 |
| Max. Negotiated Rate |
$3,609.07 |
| Rate for Payer: Cash Price |
$1,626.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,604.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,443.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,443.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,523.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,604.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,523.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,604.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,604.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,203.02
|
| Rate for Payer: Healthfirst Commercial |
$1,604.03
|
| Rate for Payer: Healthfirst Essential Plan |
$3,609.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,523.83
|
| Rate for Payer: Healthfirst QHP |
$1,604.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,122.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,604.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,363.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,122.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,604.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,203.02
|
| Rate for Payer: SOMOS Essential |
$1,203.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,604.03
|
|
|
PR GENIOPLASTY 2/> SLIDING OSTEOTOMIES
|
Professional
|
Both
|
$3,272.92
|
|
|
Service Code
|
HCPCS 21122
|
| Min. Negotiated Rate |
$612.49 |
| Max. Negotiated Rate |
$1,968.73 |
| Rate for Payer: Cash Price |
$883.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$874.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$787.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$787.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$831.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$874.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$831.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$874.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$874.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$656.24
|
| Rate for Payer: Healthfirst Commercial |
$874.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,968.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$831.24
|
| Rate for Payer: Healthfirst QHP |
$874.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$612.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$874.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$743.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$612.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$874.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$656.24
|
| Rate for Payer: SOMOS Essential |
$656.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$874.99
|
|
|
PR GENIOPLASTY AUGMENTATION
|
Professional
|
Both
|
$2,218.86
|
|
|
Service Code
|
HCPCS 21120
|
| Min. Negotiated Rate |
$415.49 |
| Max. Negotiated Rate |
$1,335.49 |
| Rate for Payer: Cash Price |
$601.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$593.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$534.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$534.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$563.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$593.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$563.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$593.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$593.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$445.16
|
| Rate for Payer: Healthfirst Commercial |
$593.55
|
| Rate for Payer: Healthfirst Essential Plan |
$1,335.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$563.87
|
| Rate for Payer: Healthfirst QHP |
$593.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$415.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$593.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$504.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$415.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$593.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$445.16
|
| Rate for Payer: SOMOS Essential |
$445.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$593.55
|
|
|
PR GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE
|
Professional
|
Both
|
$2,225.72
|
|
|
Service Code
|
HCPCS 21121
|
| Min. Negotiated Rate |
$427.40 |
| Max. Negotiated Rate |
$1,373.78 |
| Rate for Payer: Cash Price |
$607.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$610.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$549.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$549.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$580.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$610.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$580.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$610.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$610.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$457.93
|
| Rate for Payer: Healthfirst Commercial |
$610.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,373.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$580.04
|
| Rate for Payer: Healthfirst QHP |
$610.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$427.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$610.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$518.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$427.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$610.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$457.93
|
| Rate for Payer: SOMOS Essential |
$457.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$610.57
|
|
|
PR GENIOP SLIDING AGMNTJ W/INTERPOSAL BONE GRAFTS
|
Professional
|
Both
|
$3,582.43
|
|
|
Service Code
|
HCPCS 21123
|
| Min. Negotiated Rate |
$672.36 |
| Max. Negotiated Rate |
$2,161.17 |
| Rate for Payer: Cash Price |
$970.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$960.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$864.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$864.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$912.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$960.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$912.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$960.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$960.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$720.39
|
| Rate for Payer: Healthfirst Commercial |
$960.52
|
| Rate for Payer: Healthfirst Essential Plan |
$2,161.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$912.49
|
| Rate for Payer: Healthfirst QHP |
$960.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$672.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$960.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$816.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$672.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$960.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$720.39
|
| Rate for Payer: SOMOS Essential |
$720.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$960.52
|
|
|
PR GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$3,178.88
|
|
|
Service Code
|
HCPCS 91110
|
| Min. Negotiated Rate |
$561.88 |
| Max. Negotiated Rate |
$1,806.05 |
| Rate for Payer: Amida Care Medicaid |
$764.01
|
| Rate for Payer: Cash Price |
$852.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$802.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$722.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$722.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$762.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$802.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$762.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$802.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$802.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$602.02
|
| Rate for Payer: Healthfirst Commercial |
$802.69
|
| Rate for Payer: Healthfirst Essential Plan |
$1,806.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$762.56
|
| Rate for Payer: Healthfirst QHP |
$802.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$561.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$802.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$682.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$561.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$802.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$602.02
|
| Rate for Payer: SOMOS Essential |
$602.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$802.69
|
|
|
PR GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$2,738.30
|
|
|
Service Code
|
HCPCS 91110 TC
|
| Min. Negotiated Rate |
$478.10 |
| Max. Negotiated Rate |
$1,536.75 |
| Rate for Payer: Amida Care Medicaid |
$764.01
|
| Rate for Payer: Cash Price |
$731.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$683.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$614.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$614.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$648.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$683.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$648.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$683.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$683.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$512.25
|
| Rate for Payer: Healthfirst Commercial |
$683.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,536.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$648.85
|
| Rate for Payer: Healthfirst QHP |
$683.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$478.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$683.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$580.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$478.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$683.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$512.25
|
| Rate for Payer: SOMOS Essential |
$512.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$683.00
|
|
|
PR GI IMAG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$440.58
|
|
|
Service Code
|
HCPCS 91110 26
|
| Min. Negotiated Rate |
$83.78 |
| Max. Negotiated Rate |
$764.01 |
| Rate for Payer: Amida Care Medicaid |
$764.01
|
| Rate for Payer: Cash Price |
$121.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.77
|
| Rate for Payer: Healthfirst Commercial |
$119.69
|
| Rate for Payer: Healthfirst Essential Plan |
$269.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.71
|
| Rate for Payer: Healthfirst QHP |
$119.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.77
|
| Rate for Payer: SOMOS Essential |
$89.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.69
|
|
|
PR GINGIVOPLASTY EACH QUADRANT SPECIFY
|
Professional
|
Both
|
$1,325.31
|
|
|
Service Code
|
HCPCS 41872
|
| Min. Negotiated Rate |
$253.43 |
| Max. Negotiated Rate |
$814.59 |
| Rate for Payer: Cash Price |
$361.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$362.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$325.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$325.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$343.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$343.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$362.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$271.53
|
| Rate for Payer: Healthfirst Commercial |
$362.04
|
| Rate for Payer: Healthfirst Essential Plan |
$814.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$343.94
|
| Rate for Payer: Healthfirst QHP |
$362.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$253.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$362.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$307.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$253.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$271.53
|
| Rate for Payer: SOMOS Essential |
$271.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.04
|
|
|
PR GI RCNSTJ PREV ESPHG/EXCLUSION W/COLON SM INT
|
Professional
|
Both
|
$12,185.08
|
|
|
Service Code
|
HCPCS 43361
|
| Min. Negotiated Rate |
$2,254.05 |
| Max. Negotiated Rate |
$7,245.16 |
| Rate for Payer: Cash Price |
$3,245.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,220.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,898.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,898.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,059.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,220.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,059.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,220.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,220.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,415.05
|
| Rate for Payer: Healthfirst Commercial |
$3,220.07
|
| Rate for Payer: Healthfirst Essential Plan |
$7,245.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,059.07
|
| Rate for Payer: Healthfirst QHP |
$3,220.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,254.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,220.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,737.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,254.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,220.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,415.05
|
| Rate for Payer: SOMOS Essential |
$2,415.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,220.07
|
|
|
PR GI RCNSTJ PREV ESPHG/EXCLUSION W/STOMACH
|
Professional
|
Both
|
$10,028.94
|
|
|
Service Code
|
HCPCS 43360
|
| Min. Negotiated Rate |
$1,848.13 |
| Max. Negotiated Rate |
$5,940.40 |
| Rate for Payer: Cash Price |
$2,670.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,640.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,376.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,376.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,508.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,640.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,508.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,640.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,640.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,980.13
|
| Rate for Payer: Healthfirst Commercial |
$2,640.18
|
| Rate for Payer: Healthfirst Essential Plan |
$5,940.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,508.17
|
| Rate for Payer: Healthfirst QHP |
$2,640.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,848.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,640.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,244.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,848.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,640.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,980.13
|
| Rate for Payer: SOMOS Essential |
$1,980.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,640.18
|
|
|
PR GI TRACT IMAGING INTRALUMINAL COLON I&R
|
Professional
|
Both
|
$3,425.28
|
|
|
Service Code
|
HCPCS 91113 TC
|
| Min. Negotiated Rate |
$597.54 |
| Max. Negotiated Rate |
$1,920.67 |
| Rate for Payer: Cash Price |
$914.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$853.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$768.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$768.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$810.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$853.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$810.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$853.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$853.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$640.22
|
| Rate for Payer: Healthfirst Commercial |
$853.63
|
| Rate for Payer: Healthfirst Essential Plan |
$1,920.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$810.95
|
| Rate for Payer: Healthfirst QHP |
$853.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$597.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$853.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$725.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$597.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$853.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$640.22
|
| Rate for Payer: SOMOS Essential |
$640.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$853.63
|
|
|
PR GI TRACT IMAGING INTRALUMINAL COLON I&R
|
Professional
|
Both
|
$476.11
|
|
|
Service Code
|
HCPCS 91113 26
|
| Min. Negotiated Rate |
$90.49 |
| Max. Negotiated Rate |
$290.86 |
| Rate for Payer: Cash Price |
$131.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$122.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$122.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.95
|
| Rate for Payer: Healthfirst Commercial |
$129.27
|
| Rate for Payer: Healthfirst Essential Plan |
$290.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$122.81
|
| Rate for Payer: Healthfirst QHP |
$129.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$129.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$109.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.95
|
| Rate for Payer: SOMOS Essential |
$96.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.27
|
|
|
PR GI TRACT IMAGING INTRALUMINAL COLON I&R
|
Professional
|
Both
|
$3,901.38
|
|
|
Service Code
|
HCPCS 91113
|
| Min. Negotiated Rate |
$688.03 |
| Max. Negotiated Rate |
$2,211.53 |
| Rate for Payer: Cash Price |
$1,045.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$982.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$884.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$884.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$933.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$982.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$933.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$982.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$982.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$737.17
|
| Rate for Payer: Healthfirst Commercial |
$982.90
|
| Rate for Payer: Healthfirst Essential Plan |
$2,211.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$933.75
|
| Rate for Payer: Healthfirst QHP |
$982.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$688.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$982.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$835.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$688.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$982.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$737.17
|
| Rate for Payer: SOMOS Essential |
$737.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$982.90
|
|
|
PR GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP
|
Professional
|
Both
|
$417.17
|
|
|
Service Code
|
HCPCS 91112 26
|
| Min. Negotiated Rate |
$78.94 |
| Max. Negotiated Rate |
$763.81 |
| Rate for Payer: Amida Care Medicaid |
$763.81
|
| Rate for Payer: Cash Price |
$114.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.58
|
| Rate for Payer: Healthfirst Commercial |
$112.77
|
| Rate for Payer: Healthfirst Essential Plan |
$253.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.13
|
| Rate for Payer: Healthfirst QHP |
$112.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.58
|
| Rate for Payer: SOMOS Essential |
$84.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.77
|
|
|
PR GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP
|
Professional
|
Both
|
$7,079.66
|
|
|
Service Code
|
HCPCS 91112
|
| Min. Negotiated Rate |
$763.81 |
| Max. Negotiated Rate |
$3,974.38 |
| Rate for Payer: Amida Care Medicaid |
$763.81
|
| Rate for Payer: Cash Price |
$1,889.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,766.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,589.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,589.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,678.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,766.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,678.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,766.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,766.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,324.79
|
| Rate for Payer: Healthfirst Commercial |
$1,766.39
|
| Rate for Payer: Healthfirst Essential Plan |
$3,974.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,678.07
|
| Rate for Payer: Healthfirst QHP |
$1,766.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,236.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,766.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,501.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,236.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,766.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,324.79
|
| Rate for Payer: SOMOS Essential |
$1,324.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,766.39
|
|
|
PR GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP
|
Professional
|
Both
|
$6,662.50
|
|
|
Service Code
|
HCPCS 91112 TC
|
| Min. Negotiated Rate |
$763.81 |
| Max. Negotiated Rate |
$3,720.64 |
| Rate for Payer: Amida Care Medicaid |
$763.81
|
| Rate for Payer: Cash Price |
$1,775.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,653.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,488.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,488.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,570.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,653.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,570.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,653.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,653.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,240.21
|
| Rate for Payer: Healthfirst Commercial |
$1,653.62
|
| Rate for Payer: Healthfirst Essential Plan |
$3,720.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,570.94
|
| Rate for Payer: Healthfirst QHP |
$1,653.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,157.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,653.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,405.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,157.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,653.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,240.21
|
| Rate for Payer: SOMOS Essential |
$1,240.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,653.62
|
|
|
PR GLAUCOMA SCRN HGH RISK DIREC
|
Professional
|
Both
|
$177.84
|
|
|
Service Code
|
HCPCS G0118
|
| Min. Negotiated Rate |
$33.33 |
| Max. Negotiated Rate |
$107.14 |
| Rate for Payer: Cash Price |
$48.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.72
|
| Rate for Payer: Healthfirst Commercial |
$47.62
|
| Rate for Payer: Healthfirst Essential Plan |
$107.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.24
|
| Rate for Payer: Healthfirst QHP |
$47.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.72
|
| Rate for Payer: SOMOS Essential |
$35.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.62
|
|
|
PR GLAUCOMA SCRN HGH RISK DIREC
|
Professional
|
Both
|
$265.97
|
|
|
Service Code
|
HCPCS G0117
|
| Min. Negotiated Rate |
$50.30 |
| Max. Negotiated Rate |
$161.69 |
| Rate for Payer: Cash Price |
$73.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.90
|
| Rate for Payer: Healthfirst Commercial |
$71.86
|
| Rate for Payer: Healthfirst Essential Plan |
$161.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.27
|
| Rate for Payer: Healthfirst QHP |
$71.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.90
|
| Rate for Payer: SOMOS Essential |
$53.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.86
|
|
|
PR GLOSSECTOMY HEMIGLOSSECTOMY
|
Professional
|
Both
|
$5,664.16
|
|
|
Service Code
|
HCPCS 41130
|
| Min. Negotiated Rate |
$1,053.91 |
| Max. Negotiated Rate |
$3,387.55 |
| Rate for Payer: Cash Price |
$1,525.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,505.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,355.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,355.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,430.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,505.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,430.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,505.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,505.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,129.18
|
| Rate for Payer: Healthfirst Commercial |
$1,505.58
|
| Rate for Payer: Healthfirst Essential Plan |
$3,387.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,430.30
|
| Rate for Payer: Healthfirst QHP |
$1,505.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,053.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,505.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,279.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,053.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,505.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,129.18
|
| Rate for Payer: SOMOS Essential |
$1,129.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,505.58
|
|
