|
PR KETOROLAC TROMETHAMINE INJ
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS J1885
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.23
|
| Rate for Payer: Healthfirst Commercial |
$0.30
|
| Rate for Payer: Healthfirst Essential Plan |
$0.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.29
|
| Rate for Payer: Healthfirst QHP |
$0.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$0.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$0.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$0.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$0.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.23
|
| Rate for Payer: SOMOS Essential |
$0.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
|
PR KRUKENBERG PROCEDURE
|
Professional
|
Both
|
$5,157.04
|
|
|
Service Code
|
HCPCS 25915
|
| Min. Negotiated Rate |
$967.67 |
| Max. Negotiated Rate |
$3,110.38 |
| Rate for Payer: Cash Price |
$1,389.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,382.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,244.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,244.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,313.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,382.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,313.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,382.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,382.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,036.79
|
| Rate for Payer: Healthfirst Commercial |
$1,382.39
|
| Rate for Payer: Healthfirst Essential Plan |
$3,110.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,313.27
|
| Rate for Payer: Healthfirst QHP |
$1,382.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$967.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,382.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,175.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$967.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,382.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,036.79
|
| Rate for Payer: SOMOS Essential |
$1,036.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,382.39
|
|
|
PR KYPHECTOMY 3 OR MORE SEGMENTS
|
Professional
|
Both
|
$10,907.12
|
|
|
Service Code
|
HCPCS 22819
|
| Min. Negotiated Rate |
$2,037.92 |
| Max. Negotiated Rate |
$6,550.47 |
| Rate for Payer: Cash Price |
$2,928.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,911.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,620.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,620.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,765.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,911.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,765.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,911.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,911.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,183.49
|
| Rate for Payer: Healthfirst Commercial |
$2,911.32
|
| Rate for Payer: Healthfirst Essential Plan |
$6,550.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,765.75
|
| Rate for Payer: Healthfirst QHP |
$2,911.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,037.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,911.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,474.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,037.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,911.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,183.49
|
| Rate for Payer: SOMOS Essential |
$2,183.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,911.32
|
|
|
PR KYPHECTOMY SINGLE OR TWO SEGMENTS
|
Professional
|
Both
|
$9,468.24
|
|
|
Service Code
|
HCPCS 22818
|
| Min. Negotiated Rate |
$1,770.94 |
| Max. Negotiated Rate |
$5,692.30 |
| Rate for Payer: Cash Price |
$2,544.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,529.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,276.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,276.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,403.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,529.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,403.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,529.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,529.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,897.43
|
| Rate for Payer: Healthfirst Commercial |
$2,529.91
|
| Rate for Payer: Healthfirst Essential Plan |
$5,692.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,403.41
|
| Rate for Payer: Healthfirst QHP |
$2,529.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,770.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,529.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,150.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,770.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,529.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,897.43
|
| Rate for Payer: SOMOS Essential |
$1,897.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,529.91
|
|
|
PR LABYRINTHECTOMY TRANSCANAL
|
Professional
|
Both
|
$3,991.40
|
|
|
Service Code
|
HCPCS 69905
|
| Min. Negotiated Rate |
$739.30 |
| Max. Negotiated Rate |
$2,376.32 |
| Rate for Payer: Cash Price |
$1,077.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,056.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$950.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$950.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,003.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,056.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,003.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,056.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,056.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$792.11
|
| Rate for Payer: Healthfirst Commercial |
$1,056.14
|
| Rate for Payer: Healthfirst Essential Plan |
$2,376.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,003.33
|
| Rate for Payer: Healthfirst QHP |
$1,056.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$739.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,056.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$897.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$739.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,056.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$792.11
|
| Rate for Payer: SOMOS Essential |
$792.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,056.14
|
|
|
PR LABYRINTHECTOMY W/MASTOIDECTOMY
|
Professional
|
Both
|
$4,290.83
|
|
|
Service Code
|
HCPCS 69910
|
| Min. Negotiated Rate |
$796.66 |
| Max. Negotiated Rate |
$2,560.68 |
| Rate for Payer: Cash Price |
$1,158.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,138.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,024.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,024.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,081.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,138.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,081.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,138.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,138.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$853.56
|
| Rate for Payer: Healthfirst Commercial |
$1,138.08
|
| Rate for Payer: Healthfirst Essential Plan |
$2,560.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,081.18
|
| Rate for Payer: Healthfirst QHP |
$1,138.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$796.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,138.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$967.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$796.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,138.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$853.56
|
| Rate for Payer: SOMOS Essential |
$853.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,138.08
|
|
|
PR LABYRINTHOTOMY TRANSCANAL
|
Professional
|
Both
|
$532.88
|
|
|
Service Code
|
HCPCS 69801
|
| Min. Negotiated Rate |
$100.26 |
| Max. Negotiated Rate |
$322.27 |
| Rate for Payer: Cash Price |
$144.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$143.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.42
|
| Rate for Payer: Healthfirst Commercial |
$143.23
|
| Rate for Payer: Healthfirst Essential Plan |
$322.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.07
|
| Rate for Payer: Healthfirst QHP |
$143.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.42
|
| Rate for Payer: SOMOS Essential |
$107.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.23
|
|
|
PR LAIV4 VACCINE FOR INTRANASAL USE
|
Professional
|
Both
|
$93.61
|
|
|
Service Code
|
HCPCS 90672
|
| Rate for Payer: Cash Price |
$27.79
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED CERVICAL
|
Professional
|
Both
|
$12,627.93
|
|
|
Service Code
|
HCPCS 63285
|
| Min. Negotiated Rate |
$2,305.41 |
| Max. Negotiated Rate |
$7,410.24 |
| Rate for Payer: Cash Price |
$3,325.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,293.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,964.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,964.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,128.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,293.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,128.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,293.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,293.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,470.08
|
| Rate for Payer: Healthfirst Commercial |
$3,293.44
|
| Rate for Payer: Healthfirst Essential Plan |
$7,410.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,128.77
|
| Rate for Payer: Healthfirst QHP |
$3,293.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,305.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,293.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,799.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,305.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,293.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,470.08
|
| Rate for Payer: SOMOS Essential |
$2,470.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,293.44
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED THORACIC
|
Professional
|
Both
|
$12,504.28
|
|
|
Service Code
|
HCPCS 63286
|
| Min. Negotiated Rate |
$2,277.65 |
| Max. Negotiated Rate |
$7,321.03 |
| Rate for Payer: Cash Price |
$3,263.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,253.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,928.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,928.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,091.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,253.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,091.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,253.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,253.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,440.34
|
| Rate for Payer: Healthfirst Commercial |
$3,253.79
|
| Rate for Payer: Healthfirst Essential Plan |
$7,321.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,091.10
|
| Rate for Payer: Healthfirst QHP |
$3,253.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,277.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,253.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,765.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,277.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,253.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,440.34
|
| Rate for Payer: SOMOS Essential |
$2,440.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,253.79
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR
|
Professional
|
Both
|
$13,248.73
|
|
|
Service Code
|
HCPCS 63287
|
| Min. Negotiated Rate |
$2,416.74 |
| Max. Negotiated Rate |
$7,768.10 |
| Rate for Payer: Cash Price |
$3,486.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,452.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,107.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,107.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,279.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,452.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,279.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,452.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,452.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,589.37
|
| Rate for Payer: Healthfirst Commercial |
$3,452.49
|
| Rate for Payer: Healthfirst Essential Plan |
$7,768.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,279.87
|
| Rate for Payer: Healthfirst QHP |
$3,452.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,416.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,452.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,934.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,416.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,452.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,589.37
|
| Rate for Payer: SOMOS Essential |
$2,589.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,452.49
|
|
|
PR LAM BX/EXC ISPI NEO IDRL SACRAL
|
Professional
|
Both
|
$9,188.20
|
|
|
Service Code
|
HCPCS 63283
|
| Min. Negotiated Rate |
$1,681.43 |
| Max. Negotiated Rate |
$5,404.59 |
| Rate for Payer: Cash Price |
$2,424.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,402.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,161.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,161.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,281.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,402.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,281.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,402.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,402.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,801.53
|
| Rate for Payer: Healthfirst Commercial |
$2,402.04
|
| Rate for Payer: Healthfirst Essential Plan |
$5,404.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,281.94
|
| Rate for Payer: Healthfirst QHP |
$2,402.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,681.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,402.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,041.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,681.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,402.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,801.53
|
| Rate for Payer: SOMOS Essential |
$1,801.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,402.04
|
|
|
PR LAM BX/EXC ISPI NEO IDRL XMED CERVICAL
|
Professional
|
Both
|
$10,209.43
|
|
|
Service Code
|
HCPCS 63280
|
| Min. Negotiated Rate |
$1,860.49 |
| Max. Negotiated Rate |
$5,980.14 |
| Rate for Payer: Cash Price |
$2,694.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,657.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,392.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,392.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,524.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,657.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,524.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,657.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,657.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,993.38
|
| Rate for Payer: Healthfirst Commercial |
$2,657.84
|
| Rate for Payer: Healthfirst Essential Plan |
$5,980.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,524.95
|
| Rate for Payer: Healthfirst QHP |
$2,657.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,860.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,657.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,259.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,860.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,657.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,993.38
|
| Rate for Payer: SOMOS Essential |
$1,993.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,657.84
|
|
|
PR LAM BX/EXC ISPI NEO IDRL XMED LUMBAR
|
Professional
|
Both
|
$9,533.23
|
|
|
Service Code
|
HCPCS 63282
|
| Min. Negotiated Rate |
$1,748.61 |
| Max. Negotiated Rate |
$5,620.52 |
| Rate for Payer: Cash Price |
$2,514.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,498.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,248.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,248.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,373.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,498.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,373.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,498.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,498.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,873.51
|
| Rate for Payer: Healthfirst Commercial |
$2,498.01
|
| Rate for Payer: Healthfirst Essential Plan |
$5,620.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,373.11
|
| Rate for Payer: Healthfirst QHP |
$2,498.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,748.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,498.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,123.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,748.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,498.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,873.51
|
| Rate for Payer: SOMOS Essential |
$1,873.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,498.01
|
|
|
PR LAM BX/EXC ISPI NEO IDRL XMED THORACIC
|
Professional
|
Both
|
$10,103.77
|
|
|
Service Code
|
HCPCS 63281
|
| Min. Negotiated Rate |
$1,848.31 |
| Max. Negotiated Rate |
$5,940.99 |
| Rate for Payer: Cash Price |
$2,671.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,640.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,376.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,376.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,508.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,640.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,508.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,640.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,640.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,980.33
|
| Rate for Payer: Healthfirst Commercial |
$2,640.44
|
| Rate for Payer: Healthfirst Essential Plan |
$5,940.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,508.42
|
| Rate for Payer: Healthfirst QHP |
$2,640.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,848.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,640.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,244.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,848.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,640.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,980.33
|
| Rate for Payer: SOMOS Essential |
$1,980.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,640.44
|
|
|
PR LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL
|
Professional
|
Both
|
$13,475.25
|
|
|
Service Code
|
HCPCS 63290
|
| Min. Negotiated Rate |
$2,457.78 |
| Max. Negotiated Rate |
$7,900.02 |
| Rate for Payer: Cash Price |
$3,545.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,511.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,160.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,160.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,335.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,511.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,335.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,511.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,511.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,633.34
|
| Rate for Payer: Healthfirst Commercial |
$3,511.12
|
| Rate for Payer: Healthfirst Essential Plan |
$7,900.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,335.56
|
| Rate for Payer: Healthfirst QHP |
$3,511.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,457.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,511.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,984.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,457.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,511.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,633.34
|
| Rate for Payer: SOMOS Essential |
$2,633.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,511.12
|
|
|
PR LAM EXC/EVAC ISPI LESION OTH/THN NEO XDRL LUMBAR
|
Professional
|
Both
|
$6,441.75
|
|
|
Service Code
|
HCPCS 63267
|
| Min. Negotiated Rate |
$1,188.89 |
| Max. Negotiated Rate |
$3,821.42 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,698.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,528.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,528.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,613.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,698.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,613.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,698.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,698.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,273.81
|
| Rate for Payer: Healthfirst Commercial |
$1,698.41
|
| Rate for Payer: Healthfirst Essential Plan |
$3,821.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,613.49
|
| Rate for Payer: Healthfirst QHP |
$1,698.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,188.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,698.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,443.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,188.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,698.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,273.81
|
| Rate for Payer: SOMOS Essential |
$1,273.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,698.41
|
|
|
PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL CERVICAL
|
Professional
|
Both
|
$7,956.34
|
|
|
Service Code
|
HCPCS 63265
|
| Min. Negotiated Rate |
$1,453.15 |
| Max. Negotiated Rate |
$4,670.84 |
| Rate for Payer: Cash Price |
$2,106.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,075.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,868.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,868.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,972.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,075.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,972.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,075.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,075.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,556.95
|
| Rate for Payer: Healthfirst Commercial |
$2,075.93
|
| Rate for Payer: Healthfirst Essential Plan |
$4,670.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,972.13
|
| Rate for Payer: Healthfirst QHP |
$2,075.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,453.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,075.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,764.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,453.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,075.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,556.95
|
| Rate for Payer: SOMOS Essential |
$1,556.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,075.93
|
|
|
PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL SACRAL
|
Professional
|
Both
|
$6,565.09
|
|
|
Service Code
|
HCPCS 63268
|
| Min. Negotiated Rate |
$1,293.18 |
| Max. Negotiated Rate |
$4,156.65 |
| Rate for Payer: Cash Price |
$1,863.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,847.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,662.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,662.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,755.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,847.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,755.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,847.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,847.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,385.55
|
| Rate for Payer: Healthfirst Commercial |
$1,847.40
|
| Rate for Payer: Healthfirst Essential Plan |
$4,156.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,755.03
|
| Rate for Payer: Healthfirst QHP |
$1,847.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,293.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,847.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,570.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,293.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,847.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,385.55
|
| Rate for Payer: SOMOS Essential |
$1,385.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,847.40
|
|
|
PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THORACIC
|
Professional
|
Both
|
$8,170.54
|
|
|
Service Code
|
HCPCS 63266
|
| Min. Negotiated Rate |
$1,498.34 |
| Max. Negotiated Rate |
$4,816.08 |
| Rate for Payer: Cash Price |
$2,158.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,140.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,926.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,926.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,033.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,140.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,033.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,140.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,140.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,605.36
|
| Rate for Payer: Healthfirst Commercial |
$2,140.48
|
| Rate for Payer: Healthfirst Essential Plan |
$4,816.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,033.46
|
| Rate for Payer: Healthfirst QHP |
$2,140.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,498.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,140.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,819.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,498.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,140.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,605.36
|
| Rate for Payer: SOMOS Essential |
$1,605.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,140.48
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL
|
Professional
|
Both
|
$10,039.37
|
|
|
Service Code
|
HCPCS 63270
|
| Min. Negotiated Rate |
$1,833.55 |
| Max. Negotiated Rate |
$5,893.54 |
| Rate for Payer: Cash Price |
$2,644.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,619.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,357.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,357.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,488.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,619.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,488.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,619.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,619.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,964.51
|
| Rate for Payer: Healthfirst Commercial |
$2,619.35
|
| Rate for Payer: Healthfirst Essential Plan |
$5,893.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,488.38
|
| Rate for Payer: Healthfirst QHP |
$2,619.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,833.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,619.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,226.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,833.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,619.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,964.51
|
| Rate for Payer: SOMOS Essential |
$1,964.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,619.35
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR
|
Professional
|
Both
|
$8,808.70
|
|
|
Service Code
|
HCPCS 63272
|
| Min. Negotiated Rate |
$1,643.28 |
| Max. Negotiated Rate |
$5,281.97 |
| Rate for Payer: Cash Price |
$2,343.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,347.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,112.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,112.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,230.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,347.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,230.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,347.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,347.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,760.65
|
| Rate for Payer: Healthfirst Commercial |
$2,347.54
|
| Rate for Payer: Healthfirst Essential Plan |
$5,281.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,230.16
|
| Rate for Payer: Healthfirst QHP |
$2,347.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,643.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,347.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,995.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,643.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,347.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,760.65
|
| Rate for Payer: SOMOS Essential |
$1,760.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,347.54
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL
|
Professional
|
Both
|
$9,024.19
|
|
|
Service Code
|
HCPCS 63273
|
| Min. Negotiated Rate |
$1,649.52 |
| Max. Negotiated Rate |
$5,302.01 |
| Rate for Payer: Cash Price |
$2,379.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,356.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,120.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,120.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,238.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,356.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,238.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,356.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,356.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,767.34
|
| Rate for Payer: Healthfirst Commercial |
$2,356.45
|
| Rate for Payer: Healthfirst Essential Plan |
$5,302.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,238.63
|
| Rate for Payer: Healthfirst QHP |
$2,356.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,649.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,356.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,002.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,649.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,356.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,767.34
|
| Rate for Payer: SOMOS Essential |
$1,767.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,356.45
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC
|
Professional
|
Both
|
$10,006.57
|
|
|
Service Code
|
HCPCS 63271
|
| Min. Negotiated Rate |
$1,827.94 |
| Max. Negotiated Rate |
$5,875.54 |
| Rate for Payer: Cash Price |
$2,631.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,611.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,350.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,350.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,480.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,611.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,480.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,611.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,611.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,958.51
|
| Rate for Payer: Healthfirst Commercial |
$2,611.35
|
| Rate for Payer: Healthfirst Essential Plan |
$5,875.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,480.78
|
| Rate for Payer: Healthfirst QHP |
$2,611.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,827.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,611.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,219.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,827.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,611.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,958.51
|
| Rate for Payer: SOMOS Essential |
$1,958.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,611.35
|
|
|
PR LAM EXC/OCCLUSION AVM SPI CORD THORACOLUMBAR
|
Professional
|
Both
|
$14,638.33
|
|
|
Service Code
|
HCPCS 63252
|
| Min. Negotiated Rate |
$2,668.24 |
| Max. Negotiated Rate |
$8,576.48 |
| Rate for Payer: Cash Price |
$3,849.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,811.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,430.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,430.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,621.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,811.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,621.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,811.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,811.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,858.83
|
| Rate for Payer: Healthfirst Commercial |
$3,811.77
|
| Rate for Payer: Healthfirst Essential Plan |
$8,576.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,621.18
|
| Rate for Payer: Healthfirst QHP |
$3,811.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,668.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,811.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,240.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,668.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,811.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,858.83
|
| Rate for Payer: SOMOS Essential |
$2,858.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,811.77
|
|
