|
PR PROCTOPEXY W/SIGMOID RESCJ ABDL APPR
|
Professional
|
Both
|
$6,337.07
|
|
|
Service Code
|
HCPCS 45550
|
| Min. Negotiated Rate |
$1,177.36 |
| Max. Negotiated Rate |
$3,784.36 |
| Rate for Payer: Cash Price |
$1,692.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,681.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,513.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,513.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,597.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,681.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,597.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,681.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,681.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,261.45
|
| Rate for Payer: Healthfirst Commercial |
$1,681.94
|
| Rate for Payer: Healthfirst Essential Plan |
$3,784.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,597.84
|
| Rate for Payer: Healthfirst QHP |
$1,681.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,177.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,681.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,429.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,177.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,681.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,261.45
|
| Rate for Payer: SOMOS Essential |
$1,261.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,681.94
|
|
|
PR PROCTOPLASTY PROLAPSE MUCOUS MEMBRANE
|
Professional
|
Both
|
$2,629.76
|
|
|
Service Code
|
HCPCS 45505
|
| Min. Negotiated Rate |
$493.72 |
| Max. Negotiated Rate |
$1,586.97 |
| Rate for Payer: Cash Price |
$710.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$705.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$634.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$634.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$670.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$705.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$670.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$705.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$705.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$528.99
|
| Rate for Payer: Healthfirst Commercial |
$705.32
|
| Rate for Payer: Healthfirst Essential Plan |
$1,586.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$670.05
|
| Rate for Payer: Healthfirst QHP |
$705.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$493.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$705.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$599.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$493.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$705.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$528.99
|
| Rate for Payer: SOMOS Essential |
$528.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$705.32
|
|
|
PR PROCTOPLASTY STENOSIS
|
Professional
|
Both
|
$2,569.91
|
|
|
Service Code
|
HCPCS 45500
|
| Min. Negotiated Rate |
$480.32 |
| Max. Negotiated Rate |
$1,543.88 |
| Rate for Payer: Cash Price |
$689.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$686.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$617.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$651.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$686.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$651.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$686.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$686.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$514.63
|
| Rate for Payer: Healthfirst Commercial |
$686.17
|
| Rate for Payer: Healthfirst Essential Plan |
$1,543.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$651.86
|
| Rate for Payer: Healthfirst QHP |
$686.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$480.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$686.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$583.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$480.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$686.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$514.63
|
| Rate for Payer: SOMOS Essential |
$514.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$686.17
|
|
|
PR PROCTOSGMDSC RGD DX W/WO COLLJ SPEC BR/WA SPX
|
Professional
|
Both
|
$206.36
|
|
|
Service Code
|
HCPCS 45300
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$126.38 |
| Rate for Payer: Cash Price |
$56.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.13
|
| Rate for Payer: Healthfirst Commercial |
$56.17
|
| Rate for Payer: Healthfirst Essential Plan |
$126.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.36
|
| Rate for Payer: Healthfirst QHP |
$56.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.13
|
| Rate for Payer: SOMOS Essential |
$42.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.17
|
|
|
PR PROCTOSGMDSC RIGID ABLATION LESION
|
Professional
|
Both
|
$470.54
|
|
|
Service Code
|
HCPCS 45320
|
| Min. Negotiated Rate |
$88.63 |
| Max. Negotiated Rate |
$284.87 |
| Rate for Payer: Cash Price |
$125.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.96
|
| Rate for Payer: Healthfirst Commercial |
$126.61
|
| Rate for Payer: Healthfirst Essential Plan |
$284.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.28
|
| Rate for Payer: Healthfirst QHP |
$126.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.96
|
| Rate for Payer: SOMOS Essential |
$94.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.61
|
|
|
PR PROCTOSGMDSC RIGID CONTROL BLEEDING
|
Professional
|
Both
|
$468.55
|
|
|
Service Code
|
HCPCS 45317
|
| Min. Negotiated Rate |
$89.07 |
| Max. Negotiated Rate |
$286.29 |
| Rate for Payer: Cash Price |
$128.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.43
|
| Rate for Payer: Healthfirst Commercial |
$127.24
|
| Rate for Payer: Healthfirst Essential Plan |
$286.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.88
|
| Rate for Payer: Healthfirst QHP |
$127.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.43
|
| Rate for Payer: SOMOS Essential |
$95.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.24
|
|
|
PR PROCTOSGMDSC RIGID DCMPRN VOLVULUS
|
Professional
|
Both
|
$465.33
|
|
|
Service Code
|
HCPCS 45321
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$280.28 |
| Rate for Payer: Cash Price |
$124.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.43
|
| Rate for Payer: Healthfirst Commercial |
$124.57
|
| Rate for Payer: Healthfirst Essential Plan |
$280.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.34
|
| Rate for Payer: Healthfirst QHP |
$124.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.43
|
| Rate for Payer: SOMOS Essential |
$93.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.57
|
|
|
PR PROCTOSGMDSC RIGID RMVL 1 LESION CAUTERY
|
Professional
|
Both
|
$382.34
|
|
|
Service Code
|
HCPCS 45308
|
| Min. Negotiated Rate |
$71.06 |
| Max. Negotiated Rate |
$228.40 |
| Rate for Payer: Cash Price |
$101.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$101.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$91.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$101.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$96.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$101.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.13
|
| Rate for Payer: Healthfirst Commercial |
$101.51
|
| Rate for Payer: Healthfirst Essential Plan |
$228.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.43
|
| Rate for Payer: Healthfirst QHP |
$101.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$71.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$101.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$86.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$71.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$76.13
|
| Rate for Payer: SOMOS Essential |
$76.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101.51
|
|
|
PR PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ
|
Professional
|
Both
|
$403.38
|
|
|
Service Code
|
HCPCS 45309
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$242.41 |
| Rate for Payer: Cash Price |
$107.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.81
|
| Rate for Payer: Healthfirst Commercial |
$107.74
|
| Rate for Payer: Healthfirst Essential Plan |
$242.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.35
|
| Rate for Payer: Healthfirst QHP |
$107.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.81
|
| Rate for Payer: SOMOS Essential |
$80.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.74
|
|
|
PR PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE
|
Professional
|
Both
|
$477.19
|
|
|
Service Code
|
HCPCS 45315
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$286.40 |
| Rate for Payer: Cash Price |
$127.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.47
|
| Rate for Payer: Healthfirst Commercial |
$127.29
|
| Rate for Payer: Healthfirst Essential Plan |
$286.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.93
|
| Rate for Payer: Healthfirst QHP |
$127.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.47
|
| Rate for Payer: SOMOS Essential |
$95.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.29
|
|
|
PR PROCTOSGMDSC RIGID TNDSC STENT PLMT
|
Professional
|
Both
|
$524.69
|
|
|
Service Code
|
HCPCS 45327
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Cash Price |
$140.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.75
|
| Rate for Payer: Healthfirst Commercial |
$141.00
|
| Rate for Payer: Healthfirst Essential Plan |
$317.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.95
|
| Rate for Payer: Healthfirst QHP |
$141.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.75
|
| Rate for Payer: SOMOS Essential |
$105.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.00
|
|
|
PR PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$313.88
|
|
|
Service Code
|
HCPCS 45305
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$191.18 |
| Rate for Payer: Cash Price |
$85.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.73
|
| Rate for Payer: Healthfirst Commercial |
$84.97
|
| Rate for Payer: Healthfirst Essential Plan |
$191.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.72
|
| Rate for Payer: Healthfirst QHP |
$84.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.73
|
| Rate for Payer: SOMOS Essential |
$63.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.97
|
|
|
PR PROCTOSGMDSC RIGID W/DILATION
|
Professional
|
Both
|
$367.64
|
|
|
Service Code
|
HCPCS 45303
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$221.20 |
| Rate for Payer: Cash Price |
$99.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.73
|
| Rate for Payer: Healthfirst Commercial |
$98.31
|
| Rate for Payer: Healthfirst Essential Plan |
$221.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.39
|
| Rate for Payer: Healthfirst QHP |
$98.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.73
|
| Rate for Payer: SOMOS Essential |
$73.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.31
|
|
|
PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$450.73
|
|
|
Service Code
|
HCPCS 45307
|
| Min. Negotiated Rate |
$84.15 |
| Max. Negotiated Rate |
$270.47 |
| Rate for Payer: Cash Price |
$120.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$120.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.16
|
| Rate for Payer: Healthfirst Commercial |
$120.21
|
| Rate for Payer: Healthfirst Essential Plan |
$270.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.20
|
| Rate for Payer: Healthfirst QHP |
$120.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$120.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$120.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.16
|
| Rate for Payer: SOMOS Essential |
$90.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.21
|
|
|
PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX
|
Professional
|
Both
|
$44.42
|
|
|
Service Code
|
HCPCS 95115
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$28.46 |
| Rate for Payer: Amida Care Medicaid |
$4.93
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Healthfirst Commercial |
$12.65
|
| Rate for Payer: Healthfirst Essential Plan |
$28.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.02
|
| Rate for Payer: Healthfirst QHP |
$12.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$8.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$12.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$10.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$8.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.49
|
| Rate for Payer: SOMOS Essential |
$9.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.65
|
|
|
PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS
|
Professional
|
Both
|
$51.63
|
|
|
Service Code
|
HCPCS 95117
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Amida Care Medicaid |
$5.71
|
| Rate for Payer: Cash Price |
$14.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.94
|
| Rate for Payer: Healthfirst Commercial |
$14.59
|
| Rate for Payer: Healthfirst Essential Plan |
$32.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.86
|
| Rate for Payer: Healthfirst QHP |
$14.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$14.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$12.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.94
|
| Rate for Payer: SOMOS Essential |
$10.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.59
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER
|
Professional
|
Both
|
$186.73
|
|
|
Service Code
|
HCPCS 93280 TC
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$108.81 |
| Rate for Payer: Amida Care Medicaid |
$52.17
|
| Rate for Payer: Cash Price |
$50.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.27
|
| Rate for Payer: Healthfirst Commercial |
$48.36
|
| Rate for Payer: Healthfirst Essential Plan |
$108.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$45.94
|
| Rate for Payer: Healthfirst QHP |
$48.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$33.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$33.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.27
|
| Rate for Payer: SOMOS Essential |
$36.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.36
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER
|
Professional
|
Both
|
$145.04
|
|
|
Service Code
|
HCPCS 93280 26
|
| Min. Negotiated Rate |
$27.31 |
| Max. Negotiated Rate |
$87.80 |
| Rate for Payer: Amida Care Medicaid |
$52.17
|
| Rate for Payer: Cash Price |
$39.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.27
|
| Rate for Payer: Healthfirst Commercial |
$39.02
|
| Rate for Payer: Healthfirst Essential Plan |
$87.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37.07
|
| Rate for Payer: Healthfirst QHP |
$39.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$39.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.27
|
| Rate for Payer: SOMOS Essential |
$29.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.02
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER
|
Professional
|
Both
|
$331.77
|
|
|
Service Code
|
HCPCS 93280
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$196.60 |
| Rate for Payer: Amida Care Medicaid |
$52.17
|
| Rate for Payer: Cash Price |
$89.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.53
|
| Rate for Payer: Healthfirst Commercial |
$87.38
|
| Rate for Payer: Healthfirst Essential Plan |
$196.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.01
|
| Rate for Payer: Healthfirst QHP |
$87.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.53
|
| Rate for Payer: SOMOS Essential |
$65.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.38
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
|
Professional
|
Both
|
$166.29
|
|
|
Service Code
|
HCPCS 93281 26
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$98.89 |
| Rate for Payer: Amida Care Medicaid |
$61.00
|
| Rate for Payer: Cash Price |
$44.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.96
|
| Rate for Payer: Healthfirst Commercial |
$43.95
|
| Rate for Payer: Healthfirst Essential Plan |
$98.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.75
|
| Rate for Payer: Healthfirst QHP |
$43.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.96
|
| Rate for Payer: SOMOS Essential |
$32.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.95
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
|
Professional
|
Both
|
$355.88
|
|
|
Service Code
|
HCPCS 93281
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$209.43 |
| Rate for Payer: Amida Care Medicaid |
$61.00
|
| Rate for Payer: Cash Price |
$95.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$93.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$93.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.81
|
| Rate for Payer: Healthfirst Commercial |
$93.08
|
| Rate for Payer: Healthfirst Essential Plan |
$209.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.43
|
| Rate for Payer: Healthfirst QHP |
$93.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$65.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$93.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$79.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$65.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$93.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.81
|
| Rate for Payer: SOMOS Essential |
$69.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$93.08
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
|
Professional
|
Both
|
$189.60
|
|
|
Service Code
|
HCPCS 93281 TC
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$110.56 |
| Rate for Payer: Amida Care Medicaid |
$61.00
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.85
|
| Rate for Payer: Healthfirst Commercial |
$49.14
|
| Rate for Payer: Healthfirst Essential Plan |
$110.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.68
|
| Rate for Payer: Healthfirst QHP |
$49.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.85
|
| Rate for Payer: SOMOS Essential |
$36.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.14
|
|
|
PR PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS
|
Professional
|
Both
|
$357.28
|
|
|
Service Code
|
HCPCS 93623 26
|
| Min. Negotiated Rate |
$43.38 |
| Max. Negotiated Rate |
$697.86 |
| Rate for Payer: Amida Care Medicaid |
$697.86
|
| Rate for Payer: Cash Price |
$77.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.48
|
| Rate for Payer: Healthfirst Commercial |
$61.97
|
| Rate for Payer: Healthfirst Essential Plan |
$139.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.87
|
| Rate for Payer: Healthfirst QHP |
$61.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.48
|
| Rate for Payer: SOMOS Essential |
$46.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.97
|
|
|
PR PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS
|
Professional
|
Both
|
$2,853.76
|
|
|
Service Code
|
HCPCS 93623 TC
|
| Min. Negotiated Rate |
$697.86 |
| Max. Negotiated Rate |
$697.86 |
| Rate for Payer: Amida Care Medicaid |
$697.86
|
|
|
PR PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS
|
Professional
|
Both
|
$3,211.04
|
|
|
Service Code
|
HCPCS 93623
|
| Min. Negotiated Rate |
$697.86 |
| Max. Negotiated Rate |
$697.86 |
| Rate for Payer: Amida Care Medicaid |
$697.86
|
|
