|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$165.87
|
|
|
Service Code
|
HCPCS 20550
|
| Min. Negotiated Rate |
$31.11 |
| Max. Negotiated Rate |
$99.99 |
| Rate for Payer: Cash Price |
$44.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.33
|
| Rate for Payer: Healthfirst Commercial |
$44.44
|
| Rate for Payer: Healthfirst Essential Plan |
$99.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.22
|
| Rate for Payer: Healthfirst QHP |
$44.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$37.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.33
|
| Rate for Payer: SOMOS Essential |
$33.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.44
|
|
|
PR INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN
|
Professional
|
Both
|
$260.16
|
|
|
Service Code
|
HCPCS 64417
|
| Min. Negotiated Rate |
$50.53 |
| Max. Negotiated Rate |
$162.41 |
| Rate for Payer: Cash Price |
$71.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$64.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$64.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$68.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$68.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.13
|
| Rate for Payer: Healthfirst Commercial |
$72.18
|
| Rate for Payer: Healthfirst Essential Plan |
$162.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.57
|
| Rate for Payer: Healthfirst QHP |
$72.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$50.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$72.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$61.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.13
|
| Rate for Payer: SOMOS Essential |
$54.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.18
|
|
|
PR INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN
|
Professional
|
Both
|
$282.52
|
|
|
Service Code
|
HCPCS 64415
|
| Min. Negotiated Rate |
$54.03 |
| Max. Negotiated Rate |
$173.66 |
| Rate for Payer: Cash Price |
$77.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.88
|
| Rate for Payer: Healthfirst Commercial |
$77.18
|
| Rate for Payer: Healthfirst Essential Plan |
$173.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.32
|
| Rate for Payer: Healthfirst QHP |
$77.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$77.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.88
|
| Rate for Payer: SOMOS Essential |
$57.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.18
|
|
|
PR INJECTION AA&/STRD BRACH PLEX CONT NFS CATH IMG
|
Professional
|
Both
|
$320.85
|
|
|
Service Code
|
HCPCS 64416
|
| Min. Negotiated Rate |
$59.57 |
| Max. Negotiated Rate |
$191.47 |
| Rate for Payer: Cash Price |
$85.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.83
|
| Rate for Payer: Healthfirst Commercial |
$85.10
|
| Rate for Payer: Healthfirst Essential Plan |
$191.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.84
|
| Rate for Payer: Healthfirst QHP |
$85.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.83
|
| Rate for Payer: SOMOS Essential |
$63.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.10
|
|
|
PR INJECTION AA&/STRD FEM NRV CONT NFS CATH IMG GDN
|
Professional
|
Both
|
$293.30
|
|
|
Service Code
|
HCPCS 64448
|
| Min. Negotiated Rate |
$55.70 |
| Max. Negotiated Rate |
$179.03 |
| Rate for Payer: Cash Price |
$79.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.68
|
| Rate for Payer: Healthfirst Commercial |
$79.57
|
| Rate for Payer: Healthfirst Essential Plan |
$179.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.59
|
| Rate for Payer: Healthfirst QHP |
$79.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.68
|
| Rate for Payer: SOMOS Essential |
$59.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.57
|
|
|
PR INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN
|
Professional
|
Both
|
$256.87
|
|
|
Service Code
|
HCPCS 64447
|
| Min. Negotiated Rate |
$49.62 |
| Max. Negotiated Rate |
$159.50 |
| Rate for Payer: Cash Price |
$70.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.17
|
| Rate for Payer: Healthfirst Commercial |
$70.89
|
| Rate for Payer: Healthfirst Essential Plan |
$159.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.35
|
| Rate for Payer: Healthfirst QHP |
$70.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.17
|
| Rate for Payer: SOMOS Essential |
$53.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.89
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Professional
|
Both
|
$337.93
|
|
|
Service Code
|
HCPCS 64454
|
| Min. Negotiated Rate |
$64.88 |
| Max. Negotiated Rate |
$208.55 |
| Rate for Payer: Cash Price |
$92.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$88.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$88.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.52
|
| Rate for Payer: Healthfirst Commercial |
$92.69
|
| Rate for Payer: Healthfirst Essential Plan |
$208.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$88.06
|
| Rate for Payer: Healthfirst QHP |
$92.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.52
|
| Rate for Payer: SOMOS Essential |
$69.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.69
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Professional
|
Both
|
$236.88
|
|
|
Service Code
|
HCPCS 64405
|
| Min. Negotiated Rate |
$43.87 |
| Max. Negotiated Rate |
$141.01 |
| Rate for Payer: Cash Price |
$63.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.00
|
| Rate for Payer: Healthfirst Commercial |
$62.67
|
| Rate for Payer: Healthfirst Essential Plan |
$141.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.54
|
| Rate for Payer: Healthfirst QHP |
$62.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.00
|
| Rate for Payer: SOMOS Essential |
$47.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.67
|
|
|
PR INJECTION AA&/STRD ILIOINGUINAL IH NERVES
|
Professional
|
Both
|
$227.36
|
|
|
Service Code
|
HCPCS 64425
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Cash Price |
$61.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$61.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$61.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.90
|
| Rate for Payer: Healthfirst Commercial |
$61.20
|
| Rate for Payer: Healthfirst Essential Plan |
$137.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$58.14
|
| Rate for Payer: Healthfirst QHP |
$61.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$61.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$52.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.90
|
| Rate for Payer: SOMOS Essential |
$45.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.20
|
|
|
PR INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL
|
Professional
|
Both
|
$99.44
|
|
|
Service Code
|
HCPCS 64421
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$60.91 |
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.30
|
| Rate for Payer: Healthfirst Commercial |
$27.07
|
| Rate for Payer: Healthfirst Essential Plan |
$60.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.72
|
| Rate for Payer: Healthfirst QHP |
$27.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.30
|
| Rate for Payer: SOMOS Essential |
$20.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.07
|
|
|
PR INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL
|
Professional
|
Both
|
$241.68
|
|
|
Service Code
|
HCPCS 64420
|
| Min. Negotiated Rate |
$46.45 |
| Max. Negotiated Rate |
$149.31 |
| Rate for Payer: Cash Price |
$65.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.77
|
| Rate for Payer: Healthfirst Commercial |
$66.36
|
| Rate for Payer: Healthfirst Essential Plan |
$149.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.04
|
| Rate for Payer: Healthfirst QHP |
$66.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.77
|
| Rate for Payer: SOMOS Essential |
$49.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.36
|
|
|
PR INJECTION AA&/STRD LUMBAR PLEXUS CONT NFS CATH
|
Professional
|
Both
|
$255.15
|
|
|
Service Code
|
HCPCS 64449
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$166.09 |
| Rate for Payer: Cash Price |
$71.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$66.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$70.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.37
|
| Rate for Payer: Healthfirst Commercial |
$73.82
|
| Rate for Payer: Healthfirst Essential Plan |
$166.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.13
|
| Rate for Payer: Healthfirst QHP |
$73.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.37
|
| Rate for Payer: SOMOS Essential |
$55.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.82
|
|
|
PR INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG
|
Professional
|
Both
|
$336.49
|
|
|
Service Code
|
HCPCS 64451
|
| Min. Negotiated Rate |
$64.61 |
| Max. Negotiated Rate |
$207.68 |
| Rate for Payer: Cash Price |
$92.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.22
|
| Rate for Payer: Healthfirst Commercial |
$92.30
|
| Rate for Payer: Healthfirst Essential Plan |
$207.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.69
|
| Rate for Payer: Healthfirst QHP |
$92.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.22
|
| Rate for Payer: SOMOS Essential |
$69.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.30
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
Both
|
$174.76
|
|
|
Service Code
|
HCPCS 64450
|
| Min. Negotiated Rate |
$32.53 |
| Max. Negotiated Rate |
$104.56 |
| Rate for Payer: Cash Price |
$47.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.85
|
| Rate for Payer: Healthfirst Commercial |
$46.47
|
| Rate for Payer: Healthfirst Essential Plan |
$104.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.15
|
| Rate for Payer: Healthfirst QHP |
$46.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$46.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$39.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34.85
|
| Rate for Payer: SOMOS Essential |
$34.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.47
|
|
|
PR INJECTION AA&/STRD PARACERVICAL NERVE
|
Professional
|
Both
|
$187.15
|
|
|
Service Code
|
HCPCS 64435
|
| Min. Negotiated Rate |
$35.39 |
| Max. Negotiated Rate |
$113.76 |
| Rate for Payer: Cash Price |
$51.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.92
|
| Rate for Payer: Healthfirst Commercial |
$50.56
|
| Rate for Payer: Healthfirst Essential Plan |
$113.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.03
|
| Rate for Payer: Healthfirst QHP |
$50.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$42.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$37.92
|
| Rate for Payer: SOMOS Essential |
$37.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.56
|
|
|
PR INJECTION AA&/STRD PUDENDAL NERVE
|
Professional
|
Both
|
$229.95
|
|
|
Service Code
|
HCPCS 64430
|
| Min. Negotiated Rate |
$43.87 |
| Max. Negotiated Rate |
$141.01 |
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.00
|
| Rate for Payer: Healthfirst Commercial |
$62.67
|
| Rate for Payer: Healthfirst Essential Plan |
$141.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.54
|
| Rate for Payer: Healthfirst QHP |
$62.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.00
|
| Rate for Payer: SOMOS Essential |
$47.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.67
|
|
|
PR INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN
|
Professional
|
Both
|
$308.28
|
|
|
Service Code
|
HCPCS 64445
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$183.26 |
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.09
|
| Rate for Payer: Healthfirst Commercial |
$81.45
|
| Rate for Payer: Healthfirst Essential Plan |
$183.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.38
|
| Rate for Payer: Healthfirst QHP |
$81.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.09
|
| Rate for Payer: SOMOS Essential |
$61.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.45
|
|
|
PR INJECTION AA&/STRD SCIATIC NRV CONT NFS CATH IMG
|
Professional
|
Both
|
$314.58
|
|
|
Service Code
|
HCPCS 64446
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$187.58 |
| Rate for Payer: Cash Price |
$83.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$83.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$79.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$83.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$79.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.53
|
| Rate for Payer: Healthfirst Commercial |
$83.37
|
| Rate for Payer: Healthfirst Essential Plan |
$187.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$79.20
|
| Rate for Payer: Healthfirst QHP |
$83.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$83.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$83.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.53
|
| Rate for Payer: SOMOS Essential |
$62.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$83.37
|
|
|
PR INJECTION AA&/STRD SUPRASCAPULAR NERVE
|
Professional
|
Both
|
$232.44
|
|
|
Service Code
|
HCPCS 64418
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$140.90 |
| Rate for Payer: Cash Price |
$62.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.97
|
| Rate for Payer: Healthfirst Commercial |
$62.62
|
| Rate for Payer: Healthfirst Essential Plan |
$140.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.49
|
| Rate for Payer: Healthfirst QHP |
$62.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.97
|
| Rate for Payer: SOMOS Essential |
$46.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.62
|
|
|
PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH
|
Professional
|
Both
|
$226.42
|
|
|
Service Code
|
HCPCS 64400
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$140.62 |
| Rate for Payer: Cash Price |
$62.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.88
|
| Rate for Payer: Healthfirst Commercial |
$62.50
|
| Rate for Payer: Healthfirst Essential Plan |
$140.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.38
|
| Rate for Payer: Healthfirst QHP |
$62.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$46.88
|
| Rate for Payer: SOMOS Essential |
$46.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.50
|
|
|
PR INJECTION AA&/STRD VAGUS NERVE
|
Professional
|
Both
|
$193.03
|
|
|
Service Code
|
HCPCS 64408
|
| Min. Negotiated Rate |
$36.59 |
| Max. Negotiated Rate |
$117.61 |
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$49.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$52.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.20
|
| Rate for Payer: Healthfirst Commercial |
$52.27
|
| Rate for Payer: Healthfirst Essential Plan |
$117.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$49.66
|
| Rate for Payer: Healthfirst QHP |
$52.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$36.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$52.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$44.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$36.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.20
|
| Rate for Payer: SOMOS Essential |
$39.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.27
|
|
|
PR INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX
|
Professional
|
Both
|
$372.12
|
|
|
Service Code
|
HCPCS 49400
|
| Min. Negotiated Rate |
$70.18 |
| Max. Negotiated Rate |
$225.59 |
| Rate for Payer: Cash Price |
$100.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.19
|
| Rate for Payer: Healthfirst Commercial |
$100.26
|
| Rate for Payer: Healthfirst Essential Plan |
$225.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.25
|
| Rate for Payer: Healthfirst QHP |
$100.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.19
|
| Rate for Payer: SOMOS Essential |
$75.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.26
|
|
|
PR INJECTION ANES AGENT SPHENOPALATINE GANGLION
|
Professional
|
Both
|
$468.65
|
|
|
Service Code
|
HCPCS 64505
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$287.17 |
| Rate for Payer: Cash Price |
$127.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$121.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$121.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.72
|
| Rate for Payer: Healthfirst Commercial |
$127.63
|
| Rate for Payer: Healthfirst Essential Plan |
$287.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.25
|
| Rate for Payer: Healthfirst QHP |
$127.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.72
|
| Rate for Payer: SOMOS Essential |
$95.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.63
|
|
|
PR INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC
|
Professional
|
Both
|
$348.53
|
|
|
Service Code
|
HCPCS 64520
|
| Min. Negotiated Rate |
$67.25 |
| Max. Negotiated Rate |
$216.16 |
| Rate for Payer: Cash Price |
$96.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.05
|
| Rate for Payer: Healthfirst Commercial |
$96.07
|
| Rate for Payer: Healthfirst Essential Plan |
$216.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.27
|
| Rate for Payer: Healthfirst QHP |
$96.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.05
|
| Rate for Payer: SOMOS Essential |
$72.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.07
|
|
|
PR INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS
|
Professional
|
Both
|
$520.17
|
|
|
Service Code
|
HCPCS 64517
|
| Min. Negotiated Rate |
$99.74 |
| Max. Negotiated Rate |
$320.60 |
| Rate for Payer: Cash Price |
$142.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.87
|
| Rate for Payer: Healthfirst Commercial |
$142.49
|
| Rate for Payer: Healthfirst Essential Plan |
$320.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.37
|
| Rate for Payer: Healthfirst QHP |
$142.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.87
|
| Rate for Payer: SOMOS Essential |
$106.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.49
|
|
