|
PR DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM
|
Professional
|
Both
|
$846.37
|
|
|
Service Code
|
HCPCS 17276
|
| Min. Negotiated Rate |
$161.34 |
| Max. Negotiated Rate |
$518.58 |
| Rate for Payer: Cash Price |
$230.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$207.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$207.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.86
|
| Rate for Payer: Healthfirst Commercial |
$230.48
|
| Rate for Payer: Healthfirst Essential Plan |
$518.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.96
|
| Rate for Payer: Healthfirst QHP |
$230.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$161.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$161.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.86
|
| Rate for Payer: SOMOS Essential |
$172.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.48
|
|
|
PR DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR
|
Professional
|
Both
|
$2,259.99
|
|
|
Service Code
|
HCPCS 64610
|
| Min. Negotiated Rate |
$410.32 |
| Max. Negotiated Rate |
$1,318.88 |
| Rate for Payer: Cash Price |
$593.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$586.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$527.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$527.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$556.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$586.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$556.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$586.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$586.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$439.63
|
| Rate for Payer: Healthfirst Commercial |
$586.17
|
| Rate for Payer: Healthfirst Essential Plan |
$1,318.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$556.86
|
| Rate for Payer: Healthfirst QHP |
$586.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$410.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$586.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$498.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$410.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$586.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$439.63
|
| Rate for Payer: SOMOS Essential |
$439.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$586.17
|
|
|
PR DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE
|
Professional
|
Both
|
$746.80
|
|
|
Service Code
|
HCPCS 64620
|
| Min. Negotiated Rate |
$142.98 |
| Max. Negotiated Rate |
$459.58 |
| Rate for Payer: Cash Price |
$204.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$204.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$183.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$183.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.19
|
| Rate for Payer: Healthfirst Commercial |
$204.26
|
| Rate for Payer: Healthfirst Essential Plan |
$459.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.05
|
| Rate for Payer: Healthfirst QHP |
$204.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$142.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$204.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$173.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$142.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$204.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.19
|
| Rate for Payer: SOMOS Essential |
$153.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.26
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$491.16
|
|
|
Service Code
|
HCPCS 64640
|
| Min. Negotiated Rate |
$95.69 |
| Max. Negotiated Rate |
$307.57 |
| Rate for Payer: Cash Price |
$136.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$136.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$129.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$136.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$129.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$136.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$136.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.53
|
| Rate for Payer: Healthfirst Commercial |
$136.70
|
| Rate for Payer: Healthfirst Essential Plan |
$307.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.87
|
| Rate for Payer: Healthfirst QHP |
$136.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$136.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$136.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.53
|
| Rate for Payer: SOMOS Essential |
$102.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.70
|
|
|
PR DSTRJ NEUROLYTIC AGENT PUDENDAL NERVE
|
Professional
|
Both
|
$829.19
|
|
|
Service Code
|
HCPCS 64630
|
| Min. Negotiated Rate |
$156.86 |
| Max. Negotiated Rate |
$504.20 |
| Rate for Payer: Cash Price |
$223.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$224.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$201.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$212.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$224.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$212.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$168.07
|
| Rate for Payer: Healthfirst Commercial |
$224.09
|
| Rate for Payer: Healthfirst Essential Plan |
$504.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$212.89
|
| Rate for Payer: Healthfirst QHP |
$224.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$156.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$224.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$190.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$156.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$224.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$168.07
|
| Rate for Payer: SOMOS Essential |
$168.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$224.09
|
|
|
PR DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE
|
Professional
|
Both
|
$274.86
|
|
|
Service Code
|
HCPCS 64632
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$171.25 |
| Rate for Payer: Cash Price |
$75.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$68.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$68.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.08
|
| Rate for Payer: Healthfirst Commercial |
$76.11
|
| Rate for Payer: Healthfirst Essential Plan |
$171.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$72.30
|
| Rate for Payer: Healthfirst QHP |
$76.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.08
|
| Rate for Payer: SOMOS Essential |
$57.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.11
|
|
|
PR DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH
|
Professional
|
Both
|
$1,550.15
|
|
|
Service Code
|
HCPCS 64605
|
| Min. Negotiated Rate |
$373.14 |
| Max. Negotiated Rate |
$1,199.38 |
| Rate for Payer: Cash Price |
$537.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$533.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$479.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$479.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$506.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$533.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$506.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$533.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$533.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$399.80
|
| Rate for Payer: Healthfirst Commercial |
$533.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,199.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$506.41
|
| Rate for Payer: Healthfirst QHP |
$533.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$373.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$533.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$453.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$373.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$533.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$399.80
|
| Rate for Payer: SOMOS Essential |
$399.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$533.06
|
|
|
PR DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS
|
Professional
|
Both
|
$672.91
|
|
|
Service Code
|
HCPCS 64680
|
| Min. Negotiated Rate |
$127.97 |
| Max. Negotiated Rate |
$411.32 |
| Rate for Payer: Cash Price |
$182.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$164.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$173.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$173.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.11
|
| Rate for Payer: Healthfirst Commercial |
$182.81
|
| Rate for Payer: Healthfirst Essential Plan |
$411.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$173.67
|
| Rate for Payer: Healthfirst QHP |
$182.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$127.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$155.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$127.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.11
|
| Rate for Payer: SOMOS Essential |
$137.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.81
|
|
|
PR DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS
|
Professional
|
Both
|
$926.73
|
|
|
Service Code
|
HCPCS 64681
|
| Min. Negotiated Rate |
$175.41 |
| Max. Negotiated Rate |
$563.83 |
| Rate for Payer: Cash Price |
$247.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$250.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$225.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$225.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$238.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$250.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$238.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.94
|
| Rate for Payer: Healthfirst Commercial |
$250.59
|
| Rate for Payer: Healthfirst Essential Plan |
$563.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$238.06
|
| Rate for Payer: Healthfirst QHP |
$250.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$250.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$213.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$175.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$250.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$187.94
|
| Rate for Payer: SOMOS Essential |
$187.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$250.59
|
|
|
PR DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH
|
Professional
|
Both
|
$1,022.25
|
|
|
Service Code
|
HCPCS 64600
|
| Min. Negotiated Rate |
$200.94 |
| Max. Negotiated Rate |
$645.86 |
| Rate for Payer: Cash Price |
$284.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$287.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$258.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$258.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$272.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$287.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$272.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$287.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$287.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.29
|
| Rate for Payer: Healthfirst Commercial |
$287.05
|
| Rate for Payer: Healthfirst Essential Plan |
$645.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$272.70
|
| Rate for Payer: Healthfirst QHP |
$287.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$200.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$287.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$243.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$200.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$287.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$215.29
|
| Rate for Payer: SOMOS Essential |
$215.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$287.05
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
|
Professional
|
Both
|
$274.37
|
|
|
Service Code
|
HCPCS 64634
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$168.44 |
| Rate for Payer: Cash Price |
$75.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$74.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$74.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.15
|
| Rate for Payer: Healthfirst Commercial |
$74.86
|
| Rate for Payer: Healthfirst Essential Plan |
$168.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.12
|
| Rate for Payer: Healthfirst QHP |
$74.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$74.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$63.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.15
|
| Rate for Payer: SOMOS Essential |
$56.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74.86
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
|
Professional
|
Both
|
$242.94
|
|
|
Service Code
|
HCPCS 64636
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$148.52 |
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.51
|
| Rate for Payer: Healthfirst Commercial |
$66.01
|
| Rate for Payer: Healthfirst Essential Plan |
$148.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.71
|
| Rate for Payer: Healthfirst QHP |
$66.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.51
|
| Rate for Payer: SOMOS Essential |
$49.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.01
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$789.71
|
|
|
Service Code
|
HCPCS 64633
|
| Min. Negotiated Rate |
$151.46 |
| Max. Negotiated Rate |
$486.83 |
| Rate for Payer: Cash Price |
$218.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$216.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$194.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$216.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$216.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$216.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.28
|
| Rate for Payer: Healthfirst Commercial |
$216.37
|
| Rate for Payer: Healthfirst Essential Plan |
$486.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$205.55
|
| Rate for Payer: Healthfirst QHP |
$216.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$151.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$216.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$183.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$151.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$216.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.28
|
| Rate for Payer: SOMOS Essential |
$162.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$216.37
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$791.14
|
|
|
Service Code
|
HCPCS 64635
|
| Min. Negotiated Rate |
$151.30 |
| Max. Negotiated Rate |
$486.31 |
| Rate for Payer: Cash Price |
$218.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$216.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$194.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$216.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$216.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$216.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.10
|
| Rate for Payer: Healthfirst Commercial |
$216.14
|
| Rate for Payer: Healthfirst Essential Plan |
$486.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$205.33
|
| Rate for Payer: Healthfirst QHP |
$216.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$151.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$216.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$183.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$151.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$216.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.10
|
| Rate for Payer: SOMOS Essential |
$162.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$216.14
|
|
|
PR DUODENAL INTUBAT W/IMAG GUIDED MULTIPLE SPECIMEN
|
Professional
|
Both
|
$326.52
|
|
|
Service Code
|
HCPCS 43757
|
| Min. Negotiated Rate |
$61.22 |
| Max. Negotiated Rate |
$196.76 |
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.59
|
| Rate for Payer: Healthfirst Commercial |
$87.45
|
| Rate for Payer: Healthfirst Essential Plan |
$196.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.08
|
| Rate for Payer: Healthfirst QHP |
$87.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.59
|
| Rate for Payer: SOMOS Essential |
$65.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.45
|
|
|
PR DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN
|
Professional
|
Both
|
$215.81
|
|
|
Service Code
|
HCPCS 43756
|
| Min. Negotiated Rate |
$39.96 |
| Max. Negotiated Rate |
$128.45 |
| Rate for Payer: Cash Price |
$58.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.82
|
| Rate for Payer: Healthfirst Commercial |
$57.09
|
| Rate for Payer: Healthfirst Essential Plan |
$128.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.24
|
| Rate for Payer: Healthfirst QHP |
$57.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.82
|
| Rate for Payer: SOMOS Essential |
$42.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.09
|
|
|
PR DUODENAL MOTILITY MANOMETRIC STUDY
|
Professional
|
Both
|
$718.59
|
|
|
Service Code
|
HCPCS 91022
|
| Min. Negotiated Rate |
$136.49 |
| Max. Negotiated Rate |
$438.73 |
| Rate for Payer: Amida Care Medicaid |
$157.67
|
| Rate for Payer: Cash Price |
$199.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$194.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$175.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$194.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.24
|
| Rate for Payer: Healthfirst Commercial |
$194.99
|
| Rate for Payer: Healthfirst Essential Plan |
$438.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$185.24
|
| Rate for Payer: Healthfirst QHP |
$194.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$194.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$165.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$194.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$146.24
|
| Rate for Payer: SOMOS Essential |
$146.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$194.99
|
|
|
PR DUODENAL MOTILITY MANOMETRIC STUDY
|
Professional
|
Both
|
$283.29
|
|
|
Service Code
|
HCPCS 91022 26
|
| Min. Negotiated Rate |
$53.84 |
| Max. Negotiated Rate |
$173.07 |
| Rate for Payer: Amida Care Medicaid |
$157.67
|
| Rate for Payer: Cash Price |
$78.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.69
|
| Rate for Payer: Healthfirst Commercial |
$76.92
|
| Rate for Payer: Healthfirst Essential Plan |
$173.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.07
|
| Rate for Payer: Healthfirst QHP |
$76.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.69
|
| Rate for Payer: SOMOS Essential |
$57.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.92
|
|
|
PR DUODENAL MOTILITY MANOMETRIC STUDY
|
Professional
|
Both
|
$435.30
|
|
|
Service Code
|
HCPCS 91022 TC
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$265.66 |
| Rate for Payer: Amida Care Medicaid |
$157.67
|
| Rate for Payer: Cash Price |
$121.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.55
|
| Rate for Payer: Healthfirst Commercial |
$118.07
|
| Rate for Payer: Healthfirst Essential Plan |
$265.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.17
|
| Rate for Payer: Healthfirst QHP |
$118.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.55
|
| Rate for Payer: SOMOS Essential |
$88.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.07
|
|
|
PR DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$3,716.16
|
|
|
Service Code
|
HCPCS 44010
|
| Min. Negotiated Rate |
$685.36 |
| Max. Negotiated Rate |
$2,202.95 |
| Rate for Payer: Cash Price |
$996.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$979.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$881.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$881.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$930.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$979.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$930.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$979.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$979.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$734.32
|
| Rate for Payer: Healthfirst Commercial |
$979.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,202.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$930.14
|
| Rate for Payer: Healthfirst QHP |
$979.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$685.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$979.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$832.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$685.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$979.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$734.32
|
| Rate for Payer: SOMOS Essential |
$734.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$979.09
|
|
|
PR DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ
|
Professional
|
Both
|
$8,112.37
|
|
|
Service Code
|
HCPCS 48547
|
| Min. Negotiated Rate |
$1,497.08 |
| Max. Negotiated Rate |
$4,812.03 |
| Rate for Payer: Cash Price |
$2,156.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,138.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,924.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,924.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,031.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,138.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,031.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,138.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,138.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,604.01
|
| Rate for Payer: Healthfirst Commercial |
$2,138.68
|
| Rate for Payer: Healthfirst Essential Plan |
$4,812.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,031.75
|
| Rate for Payer: Healthfirst QHP |
$2,138.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,497.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,138.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,817.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,497.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,138.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,604.01
|
| Rate for Payer: SOMOS Essential |
$1,604.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,138.68
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD
|
Professional
|
Both
|
$161.77
|
|
|
Service Code
|
HCPCS 93985 26
|
| Min. Negotiated Rate |
$30.35 |
| Max. Negotiated Rate |
$178.90 |
| Rate for Payer: Amida Care Medicaid |
$178.90
|
| Rate for Payer: Cash Price |
$42.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.52
|
| Rate for Payer: Healthfirst Commercial |
$43.36
|
| Rate for Payer: Healthfirst Essential Plan |
$97.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.19
|
| Rate for Payer: Healthfirst QHP |
$43.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$43.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.52
|
| Rate for Payer: SOMOS Essential |
$32.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.36
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD
|
Professional
|
Both
|
$913.68
|
|
|
Service Code
|
HCPCS 93985 TC
|
| Min. Negotiated Rate |
$170.46 |
| Max. Negotiated Rate |
$547.92 |
| Rate for Payer: Amida Care Medicaid |
$178.90
|
| Rate for Payer: Cash Price |
$249.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$243.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$219.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$219.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$231.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$243.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$231.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.64
|
| Rate for Payer: Healthfirst Commercial |
$243.52
|
| Rate for Payer: Healthfirst Essential Plan |
$547.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.34
|
| Rate for Payer: Healthfirst QHP |
$243.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$170.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$243.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$206.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$170.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$243.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$182.64
|
| Rate for Payer: SOMOS Essential |
$182.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$243.52
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD
|
Professional
|
Both
|
$1,075.48
|
|
|
Service Code
|
HCPCS 93985
|
| Min. Negotiated Rate |
$178.90 |
| Max. Negotiated Rate |
$645.48 |
| Rate for Payer: Amida Care Medicaid |
$178.90
|
| Rate for Payer: Cash Price |
$292.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$286.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$258.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$258.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$272.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$286.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$272.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$286.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$286.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.16
|
| Rate for Payer: Healthfirst Commercial |
$286.88
|
| Rate for Payer: Healthfirst Essential Plan |
$645.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$272.54
|
| Rate for Payer: Healthfirst QHP |
$286.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$200.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$286.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$243.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$200.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$286.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$215.16
|
| Rate for Payer: SOMOS Essential |
$215.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$286.88
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD
|
Professional
|
Both
|
$456.86
|
|
|
Service Code
|
HCPCS 93986 TC
|
| Min. Negotiated Rate |
$90.96 |
| Max. Negotiated Rate |
$320.33 |
| Rate for Payer: Amida Care Medicaid |
$90.96
|
| Rate for Payer: Cash Price |
$145.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.78
|
| Rate for Payer: Healthfirst Commercial |
$142.37
|
| Rate for Payer: Healthfirst Essential Plan |
$320.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.25
|
| Rate for Payer: Healthfirst QHP |
$142.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.78
|
| Rate for Payer: SOMOS Essential |
$106.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.37
|
|
