|
PR SHUNT SUBCLAVIAN PULMONARY ARTERY
|
Professional
|
Both
|
$5,623.98
|
|
|
Service Code
|
HCPCS 33750
|
| Min. Negotiated Rate |
$1,035.80 |
| Max. Negotiated Rate |
$3,329.37 |
| Rate for Payer: Cash Price |
$1,495.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,479.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,331.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,331.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,405.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,479.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,405.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,479.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,479.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,109.79
|
| Rate for Payer: Healthfirst Commercial |
$1,479.72
|
| Rate for Payer: Healthfirst Essential Plan |
$3,329.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,405.73
|
| Rate for Payer: Healthfirst QHP |
$1,479.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,035.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,479.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,257.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,035.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,479.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,109.79
|
| Rate for Payer: SOMOS Essential |
$1,109.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,479.72
|
|
|
PR SHUNT SUPERIOR VENA CAVA PULM ARTERY BOTH LUNGS
|
Professional
|
Both
|
$6,334.41
|
|
|
Service Code
|
HCPCS 33767
|
| Min. Negotiated Rate |
$1,165.63 |
| Max. Negotiated Rate |
$3,746.66 |
| Rate for Payer: Cash Price |
$1,683.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,665.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,498.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,498.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,581.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,665.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,581.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,665.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,665.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,248.88
|
| Rate for Payer: Healthfirst Commercial |
$1,665.18
|
| Rate for Payer: Healthfirst Essential Plan |
$3,746.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,581.92
|
| Rate for Payer: Healthfirst QHP |
$1,665.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,165.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,665.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,415.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,165.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,665.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,248.88
|
| Rate for Payer: SOMOS Essential |
$1,248.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,665.18
|
|
|
PR SHUNT SUPERIOR VENA CAVA PULMONARY ART 1 LUNG
|
Professional
|
Both
|
$5,938.00
|
|
|
Service Code
|
HCPCS 33766
|
| Min. Negotiated Rate |
$1,092.69 |
| Max. Negotiated Rate |
$3,512.23 |
| Rate for Payer: Cash Price |
$1,577.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,560.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,404.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,404.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,482.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,560.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,482.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,560.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,560.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,170.74
|
| Rate for Payer: Healthfirst Commercial |
$1,560.99
|
| Rate for Payer: Healthfirst Essential Plan |
$3,512.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,482.94
|
| Rate for Payer: Healthfirst QHP |
$1,560.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,092.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,560.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,326.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,092.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,560.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,170.74
|
| Rate for Payer: SOMOS Essential |
$1,170.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,560.99
|
|
|
PR SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM
|
Professional
|
Both
|
$262.61
|
|
|
Service Code
|
HCPCS 11311
|
| Min. Negotiated Rate |
$49.81 |
| Max. Negotiated Rate |
$160.11 |
| Rate for Payer: Cash Price |
$71.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$71.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$71.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$71.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.37
|
| Rate for Payer: Healthfirst Commercial |
$71.16
|
| Rate for Payer: Healthfirst Essential Plan |
$160.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.60
|
| Rate for Payer: Healthfirst QHP |
$71.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$71.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$71.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.37
|
| Rate for Payer: SOMOS Essential |
$53.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$71.16
|
|
|
PR SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM
|
Professional
|
Both
|
$318.57
|
|
|
Service Code
|
HCPCS 11312
|
| Min. Negotiated Rate |
$59.03 |
| Max. Negotiated Rate |
$189.74 |
| Rate for Payer: Cash Price |
$83.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.25
|
| Rate for Payer: Healthfirst Commercial |
$84.33
|
| Rate for Payer: Healthfirst Essential Plan |
$189.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.11
|
| Rate for Payer: Healthfirst QHP |
$84.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.25
|
| Rate for Payer: SOMOS Essential |
$63.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.33
|
|
|
PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM
|
Professional
|
Both
|
$214.83
|
|
|
Service Code
|
HCPCS 11301
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$130.84 |
| Rate for Payer: Cash Price |
$58.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$52.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.61
|
| Rate for Payer: Healthfirst Commercial |
$58.15
|
| Rate for Payer: Healthfirst Essential Plan |
$130.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$55.24
|
| Rate for Payer: Healthfirst QHP |
$58.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$58.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.61
|
| Rate for Payer: SOMOS Essential |
$43.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.15
|
|
|
PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM
|
Professional
|
Both
|
$296.94
|
|
|
Service Code
|
HCPCS 11303
|
| Min. Negotiated Rate |
$56.74 |
| Max. Negotiated Rate |
$182.38 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.80
|
| Rate for Payer: Healthfirst Commercial |
$81.06
|
| Rate for Payer: Healthfirst Essential Plan |
$182.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.01
|
| Rate for Payer: Healthfirst QHP |
$81.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.80
|
| Rate for Payer: SOMOS Essential |
$60.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.06
|
|
|
PR SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM
|
Professional
|
Both
|
$249.31
|
|
|
Service Code
|
HCPCS 11302
|
| Min. Negotiated Rate |
$47.35 |
| Max. Negotiated Rate |
$152.21 |
| Rate for Payer: Cash Price |
$67.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.74
|
| Rate for Payer: Healthfirst Commercial |
$67.65
|
| Rate for Payer: Healthfirst Essential Plan |
$152.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.27
|
| Rate for Payer: Healthfirst QHP |
$67.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$47.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$67.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$57.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$47.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.74
|
| Rate for Payer: SOMOS Essential |
$50.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.65
|
|
|
PR SIALOLITHOTOMY PRTD XTRORAL/COMP INTRAORAL
|
Professional
|
Both
|
$1,490.37
|
|
|
Service Code
|
HCPCS 42340
|
| Min. Negotiated Rate |
$281.39 |
| Max. Negotiated Rate |
$904.46 |
| Rate for Payer: Cash Price |
$406.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$401.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$361.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$361.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$381.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$401.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$381.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$401.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$401.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$301.49
|
| Rate for Payer: Healthfirst Commercial |
$401.98
|
| Rate for Payer: Healthfirst Essential Plan |
$904.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$381.88
|
| Rate for Payer: Healthfirst QHP |
$401.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$281.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$401.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$341.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$281.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$401.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$301.49
|
| Rate for Payer: SOMOS Essential |
$301.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$401.98
|
|
|
PR SIALOLITHOTOMY SUBMNDBLR SUBMAX COMP INTRAORAL
|
Professional
|
Both
|
$1,132.15
|
|
|
Service Code
|
HCPCS 42335
|
| Min. Negotiated Rate |
$216.36 |
| Max. Negotiated Rate |
$695.43 |
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$309.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$278.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$278.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$293.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$309.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$293.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$309.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$309.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$231.81
|
| Rate for Payer: Healthfirst Commercial |
$309.08
|
| Rate for Payer: Healthfirst Essential Plan |
$695.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$293.63
|
| Rate for Payer: Healthfirst QHP |
$309.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$216.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$309.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$262.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$216.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$309.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$231.81
|
| Rate for Payer: SOMOS Essential |
$231.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$309.08
|
|
|
PR SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL
|
Professional
|
Both
|
$711.59
|
|
|
Service Code
|
HCPCS 42330
|
| Min. Negotiated Rate |
$134.32 |
| Max. Negotiated Rate |
$431.75 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$182.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.92
|
| Rate for Payer: Healthfirst Commercial |
$191.89
|
| Rate for Payer: Healthfirst Essential Plan |
$431.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$182.30
|
| Rate for Payer: Healthfirst QHP |
$191.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$163.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.92
|
| Rate for Payer: SOMOS Essential |
$143.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.89
|
|
|
PR SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES
|
Professional
|
Both
|
$671.97
|
|
|
Service Code
|
HCPCS 45346
|
| Min. Negotiated Rate |
$126.11 |
| Max. Negotiated Rate |
$405.34 |
| Rate for Payer: Cash Price |
$181.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$162.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.11
|
| Rate for Payer: Healthfirst Commercial |
$180.15
|
| Rate for Payer: Healthfirst Essential Plan |
$405.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$171.14
|
| Rate for Payer: Healthfirst QHP |
$180.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$180.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.11
|
| Rate for Payer: SOMOS Essential |
$135.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.15
|
|
|
PR SIGMOIDOSCOPY FLX CONTROL BLEEDING
|
Professional
|
Both
|
$492.84
|
|
|
Service Code
|
HCPCS 45334
|
| Min. Negotiated Rate |
$92.58 |
| Max. Negotiated Rate |
$297.56 |
| Rate for Payer: Cash Price |
$133.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$125.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.19
|
| Rate for Payer: Healthfirst Commercial |
$132.25
|
| Rate for Payer: Healthfirst Essential Plan |
$297.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.64
|
| Rate for Payer: Healthfirst QHP |
$132.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.19
|
| Rate for Payer: SOMOS Essential |
$99.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.25
|
|
|
PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD
|
Professional
|
Both
|
$238.67
|
|
|
Service Code
|
HCPCS 45330
|
| Min. Negotiated Rate |
$45.99 |
| Max. Negotiated Rate |
$147.82 |
| Rate for Payer: Cash Price |
$65.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.27
|
| Rate for Payer: Healthfirst Commercial |
$65.70
|
| Rate for Payer: Healthfirst Essential Plan |
$147.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.41
|
| Rate for Payer: Healthfirst QHP |
$65.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$65.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$55.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.27
|
| Rate for Payer: SOMOS Essential |
$49.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.70
|
|
|
PR SIGMOIDOSCOPY FLX NDSC US XM
|
Professional
|
Both
|
$515.06
|
|
|
Service Code
|
HCPCS 45341
|
| Min. Negotiated Rate |
$97.53 |
| Max. Negotiated Rate |
$313.49 |
| Rate for Payer: Cash Price |
$140.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$139.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$132.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$139.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$132.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.50
|
| Rate for Payer: Healthfirst Commercial |
$139.33
|
| Rate for Payer: Healthfirst Essential Plan |
$313.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$132.36
|
| Rate for Payer: Healthfirst QHP |
$139.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$139.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$118.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$139.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$104.50
|
| Rate for Payer: SOMOS Essential |
$104.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$139.33
|
|
|
PR SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT
|
Professional
|
Both
|
$638.26
|
|
|
Service Code
|
HCPCS 45347
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$388.60 |
| Rate for Payer: Cash Price |
$174.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$164.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$164.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.53
|
| Rate for Payer: Healthfirst Commercial |
$172.71
|
| Rate for Payer: Healthfirst Essential Plan |
$388.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$164.07
|
| Rate for Payer: Healthfirst QHP |
$172.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$120.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$172.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$120.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.53
|
| Rate for Payer: SOMOS Essential |
$129.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.71
|
|
|
PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT
|
Professional
|
Both
|
$332.33
|
|
|
Service Code
|
HCPCS 45340
|
| Min. Negotiated Rate |
$61.79 |
| Max. Negotiated Rate |
$198.61 |
| Rate for Payer: Cash Price |
$90.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$88.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$79.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$79.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$88.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.20
|
| Rate for Payer: Healthfirst Commercial |
$88.27
|
| Rate for Payer: Healthfirst Essential Plan |
$198.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.86
|
| Rate for Payer: Healthfirst QHP |
$88.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$88.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$75.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$88.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$66.20
|
| Rate for Payer: SOMOS Essential |
$66.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$88.27
|
|
|
PR SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX
|
Professional
|
Both
|
$718.45
|
|
|
Service Code
|
HCPCS 45342
|
| Min. Negotiated Rate |
$134.11 |
| Max. Negotiated Rate |
$431.08 |
| Rate for Payer: Cash Price |
$194.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$182.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.69
|
| Rate for Payer: Healthfirst Commercial |
$191.59
|
| Rate for Payer: Healthfirst Essential Plan |
$431.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$182.01
|
| Rate for Payer: Healthfirst QHP |
$191.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$162.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.69
|
| Rate for Payer: SOMOS Essential |
$143.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.59
|
|
|
PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$301.84
|
|
|
Service Code
|
HCPCS 45331
|
| Min. Negotiated Rate |
$58.05 |
| Max. Negotiated Rate |
$186.59 |
| Rate for Payer: Cash Price |
$82.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.20
|
| Rate for Payer: Healthfirst Commercial |
$82.93
|
| Rate for Payer: Healthfirst Essential Plan |
$186.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.78
|
| Rate for Payer: Healthfirst QHP |
$82.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.20
|
| Rate for Payer: SOMOS Essential |
$62.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.93
|
|
|
PR SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)
|
Professional
|
Both
|
$422.98
|
|
|
Service Code
|
HCPCS 45350
|
| Min. Negotiated Rate |
$79.92 |
| Max. Negotiated Rate |
$256.88 |
| Rate for Payer: Cash Price |
$115.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$114.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$114.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.63
|
| Rate for Payer: Healthfirst Commercial |
$114.17
|
| Rate for Payer: Healthfirst Essential Plan |
$256.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.46
|
| Rate for Payer: Healthfirst QHP |
$114.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$114.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$114.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.63
|
| Rate for Payer: SOMOS Essential |
$85.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.17
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$440.06
|
|
|
Service Code
|
HCPCS 45332
|
| Min. Negotiated Rate |
$83.37 |
| Max. Negotiated Rate |
$267.98 |
| Rate for Payer: Cash Price |
$120.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$119.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$107.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$119.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$119.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$119.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$89.33
|
| Rate for Payer: Healthfirst Commercial |
$119.10
|
| Rate for Payer: Healthfirst Essential Plan |
$267.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$113.14
|
| Rate for Payer: Healthfirst QHP |
$119.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$83.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$119.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$101.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$83.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$119.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$89.33
|
| Rate for Payer: SOMOS Essential |
$89.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.10
|
|
|
PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS
|
Professional
|
Both
|
$397.95
|
|
|
Service Code
|
HCPCS 45333
|
| Min. Negotiated Rate |
$75.31 |
| Max. Negotiated Rate |
$242.08 |
| Rate for Payer: Cash Price |
$108.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$102.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.69
|
| Rate for Payer: Healthfirst Commercial |
$107.59
|
| Rate for Payer: Healthfirst Essential Plan |
$242.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.21
|
| Rate for Payer: Healthfirst QHP |
$107.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$75.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$107.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$91.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$75.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$80.69
|
| Rate for Payer: SOMOS Essential |
$80.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.59
|
|
|
PR SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG
|
Professional
|
Both
|
$48.44
|
|
|
Service Code
|
HCPCS 93278 26
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Amida Care Medicaid |
$38.74
|
| Rate for Payer: Cash Price |
$13.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.12
|
| Rate for Payer: Healthfirst Commercial |
$13.50
|
| Rate for Payer: Healthfirst Essential Plan |
$30.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.82
|
| Rate for Payer: Healthfirst QHP |
$13.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.12
|
| Rate for Payer: SOMOS Essential |
$10.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.50
|
|
|
PR SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG
|
Professional
|
Both
|
$73.19
|
|
|
Service Code
|
HCPCS 93278 TC
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$51.16 |
| Rate for Payer: Amida Care Medicaid |
$38.74
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.05
|
| Rate for Payer: Healthfirst Commercial |
$22.74
|
| Rate for Payer: Healthfirst Essential Plan |
$51.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.60
|
| Rate for Payer: Healthfirst QHP |
$22.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.05
|
| Rate for Payer: SOMOS Essential |
$17.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.74
|
|
|
PR SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG
|
Professional
|
Both
|
$121.59
|
|
|
Service Code
|
HCPCS 93278
|
| Min. Negotiated Rate |
$25.37 |
| Max. Negotiated Rate |
$81.54 |
| Rate for Payer: Amida Care Medicaid |
$38.74
|
| Rate for Payer: Cash Price |
$36.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.18
|
| Rate for Payer: Healthfirst Commercial |
$36.24
|
| Rate for Payer: Healthfirst Essential Plan |
$81.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.43
|
| Rate for Payer: Healthfirst QHP |
$36.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.18
|
| Rate for Payer: SOMOS Essential |
$27.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.24
|
|
