|
PR LAM EXC/OCCLUSION AVM SPINAL CORD CERVICAL
|
Professional
|
Both
|
$14,327.67
|
|
|
Service Code
|
HCPCS 63250
|
| Min. Negotiated Rate |
$2,610.87 |
| Max. Negotiated Rate |
$8,392.09 |
| Rate for Payer: Cash Price |
$3,766.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,729.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,356.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,356.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,543.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,729.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,543.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,729.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,729.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,797.36
|
| Rate for Payer: Healthfirst Commercial |
$3,729.82
|
| Rate for Payer: Healthfirst Essential Plan |
$8,392.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,543.33
|
| Rate for Payer: Healthfirst QHP |
$3,729.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,610.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,729.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,170.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,610.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,729.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,797.36
|
| Rate for Payer: SOMOS Essential |
$2,797.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,729.82
|
|
|
PR LAM EXC/OCCLUSION AVM SPINAL CORD THORACIC
|
Professional
|
Both
|
$14,645.05
|
|
|
Service Code
|
HCPCS 63251
|
| Min. Negotiated Rate |
$2,668.48 |
| Max. Negotiated Rate |
$8,577.25 |
| Rate for Payer: Cash Price |
$3,849.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,812.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,430.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,430.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,621.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,812.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,621.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,812.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,812.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,859.08
|
| Rate for Payer: Healthfirst Commercial |
$3,812.11
|
| Rate for Payer: Healthfirst Essential Plan |
$8,577.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,621.50
|
| Rate for Payer: Healthfirst QHP |
$3,812.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,668.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,812.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,240.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,668.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,812.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,859.08
|
| Rate for Payer: SOMOS Essential |
$2,859.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,812.11
|
|
|
PR LAM FACETEC/FORAMOT DRG ARTHRD LMBR EA ADDL SGM
|
Professional
|
Both
|
$1,058.37
|
|
|
Service Code
|
HCPCS 63053
|
| Min. Negotiated Rate |
$194.38 |
| Max. Negotiated Rate |
$624.78 |
| Rate for Payer: Cash Price |
$281.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$277.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$249.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$263.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$277.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$263.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$277.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$277.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.26
|
| Rate for Payer: Healthfirst Commercial |
$277.68
|
| Rate for Payer: Healthfirst Essential Plan |
$624.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$263.80
|
| Rate for Payer: Healthfirst QHP |
$277.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$277.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$236.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$277.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.26
|
| Rate for Payer: SOMOS Essential |
$208.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$277.68
|
|
|
PR LAM FACETEC/FORAMOT DRG ARTHRD LUMBAR 1 VRT SGM
|
Professional
|
Both
|
$1,198.23
|
|
|
Service Code
|
HCPCS 63052
|
| Min. Negotiated Rate |
$220.19 |
| Max. Negotiated Rate |
$707.74 |
| Rate for Payer: Cash Price |
$316.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$314.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$283.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$283.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$298.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$314.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$298.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$314.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$314.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$235.91
|
| Rate for Payer: Healthfirst Commercial |
$314.55
|
| Rate for Payer: Healthfirst Essential Plan |
$707.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$298.82
|
| Rate for Payer: Healthfirst QHP |
$314.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$220.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$314.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$267.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$220.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$314.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$235.91
|
| Rate for Payer: SOMOS Essential |
$235.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$314.55
|
|
|
PR LAM FACETECTOMY&FORAMOT 1 VRT SGM EA ADDL SGM
|
Professional
|
Both
|
$973.35
|
|
|
Service Code
|
HCPCS 63048
|
| Min. Negotiated Rate |
$179.09 |
| Max. Negotiated Rate |
$575.66 |
| Rate for Payer: Cash Price |
$258.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$255.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$230.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$230.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$243.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$255.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$243.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$255.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$255.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.89
|
| Rate for Payer: Healthfirst Commercial |
$255.85
|
| Rate for Payer: Healthfirst Essential Plan |
$575.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$243.06
|
| Rate for Payer: Healthfirst QHP |
$255.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$179.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$255.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$217.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$179.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$255.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$191.89
|
| Rate for Payer: SOMOS Essential |
$191.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$255.85
|
|
|
PR LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT CERVICAL
|
Professional
|
Both
|
$6,064.10
|
|
|
Service Code
|
HCPCS 63045
|
| Min. Negotiated Rate |
$1,117.42 |
| Max. Negotiated Rate |
$3,591.70 |
| Rate for Payer: Cash Price |
$1,610.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,596.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,436.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,436.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,516.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,596.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,516.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,596.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,596.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,197.23
|
| Rate for Payer: Healthfirst Commercial |
$1,596.31
|
| Rate for Payer: Healthfirst Essential Plan |
$3,591.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,516.49
|
| Rate for Payer: Healthfirst QHP |
$1,596.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,117.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,596.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,356.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,117.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,596.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,197.23
|
| Rate for Payer: SOMOS Essential |
$1,197.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,596.31
|
|
|
PR LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT LUMBAR
|
Professional
|
Both
|
$5,130.06
|
|
|
Service Code
|
HCPCS 63047
|
| Min. Negotiated Rate |
$951.16 |
| Max. Negotiated Rate |
$3,057.30 |
| Rate for Payer: Cash Price |
$1,367.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,358.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,222.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,222.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,290.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,358.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,290.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,358.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,358.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,019.10
|
| Rate for Payer: Healthfirst Commercial |
$1,358.80
|
| Rate for Payer: Healthfirst Essential Plan |
$3,057.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,290.86
|
| Rate for Payer: Healthfirst QHP |
$1,358.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$951.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,358.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,154.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$951.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,358.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,019.10
|
| Rate for Payer: SOMOS Essential |
$1,019.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,358.80
|
|
|
PR LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT THORACIC
|
Professional
|
Both
|
$5,735.07
|
|
|
Service Code
|
HCPCS 63046
|
| Min. Negotiated Rate |
$1,061.96 |
| Max. Negotiated Rate |
$3,413.45 |
| Rate for Payer: Cash Price |
$1,528.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,517.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,365.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,365.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,441.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,517.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,441.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,517.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,517.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,137.82
|
| Rate for Payer: Healthfirst Commercial |
$1,517.09
|
| Rate for Payer: Healthfirst Essential Plan |
$3,413.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,441.24
|
| Rate for Payer: Healthfirst QHP |
$1,517.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,061.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,517.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,289.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,061.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,517.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,137.82
|
| Rate for Payer: SOMOS Essential |
$1,137.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,517.09
|
|
|
PR LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL
|
Professional
|
Both
|
$3,922.10
|
|
|
Service Code
|
HCPCS 63655
|
| Min. Negotiated Rate |
$729.08 |
| Max. Negotiated Rate |
$2,343.47 |
| Rate for Payer: Cash Price |
$1,046.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,041.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$937.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$937.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$989.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,041.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$989.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,041.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,041.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$781.15
|
| Rate for Payer: Healthfirst Commercial |
$1,041.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,343.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$989.46
|
| Rate for Payer: Healthfirst QHP |
$1,041.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$729.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,041.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$885.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$729.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,041.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$781.15
|
| Rate for Payer: SOMOS Essential |
$781.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,041.54
|
|
|
PR LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL
|
Professional
|
Both
|
$8,655.71
|
|
|
Service Code
|
HCPCS 63275
|
| Min. Negotiated Rate |
$1,573.89 |
| Max. Negotiated Rate |
$5,058.92 |
| Rate for Payer: Cash Price |
$2,269.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,248.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,023.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,023.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,135.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,248.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,135.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,248.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,248.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,686.31
|
| Rate for Payer: Healthfirst Commercial |
$2,248.41
|
| Rate for Payer: Healthfirst Essential Plan |
$5,058.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,135.99
|
| Rate for Payer: Healthfirst QHP |
$2,248.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,573.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,248.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,911.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,573.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,248.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,686.31
|
| Rate for Payer: SOMOS Essential |
$1,686.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,248.41
|
|
|
PR LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR
|
Professional
|
Both
|
$7,392.39
|
|
|
Service Code
|
HCPCS 63277
|
| Min. Negotiated Rate |
$1,359.72 |
| Max. Negotiated Rate |
$4,370.53 |
| Rate for Payer: Cash Price |
$1,954.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,942.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,748.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,748.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,845.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,942.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,845.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,942.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,942.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,456.85
|
| Rate for Payer: Healthfirst Commercial |
$1,942.46
|
| Rate for Payer: Healthfirst Essential Plan |
$4,370.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,845.34
|
| Rate for Payer: Healthfirst QHP |
$1,942.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,359.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,942.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,651.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,359.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,942.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,456.85
|
| Rate for Payer: SOMOS Essential |
$1,456.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,942.46
|
|
|
PR LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL
|
Professional
|
Both
|
$7,691.88
|
|
|
Service Code
|
HCPCS 63278
|
| Min. Negotiated Rate |
$1,409.88 |
| Max. Negotiated Rate |
$4,531.77 |
| Rate for Payer: Cash Price |
$2,031.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,014.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,812.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,812.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,913.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,014.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,913.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,014.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,014.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,510.59
|
| Rate for Payer: Healthfirst Commercial |
$2,014.12
|
| Rate for Payer: Healthfirst Essential Plan |
$4,531.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,913.41
|
| Rate for Payer: Healthfirst QHP |
$2,014.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,409.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,014.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,712.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,409.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,014.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,510.59
|
| Rate for Payer: SOMOS Essential |
$1,510.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,014.12
|
|
|
PR LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC
|
Professional
|
Both
|
$8,530.48
|
|
|
Service Code
|
HCPCS 63276
|
| Min. Negotiated Rate |
$1,563.77 |
| Max. Negotiated Rate |
$5,026.39 |
| Rate for Payer: Cash Price |
$2,256.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,233.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,010.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,010.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,122.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,233.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,122.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,233.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,233.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,675.46
|
| Rate for Payer: Healthfirst Commercial |
$2,233.95
|
| Rate for Payer: Healthfirst Essential Plan |
$5,026.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,122.25
|
| Rate for Payer: Healthfirst QHP |
$2,233.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,563.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,233.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,898.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,563.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,233.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,675.46
|
| Rate for Payer: SOMOS Essential |
$1,675.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,233.95
|
|
|
PR LAMINECTOMY RELEASE TETHERED SPINAL CORD LUMBAR
|
Professional
|
Both
|
$7,261.07
|
|
|
Service Code
|
HCPCS 63200
|
| Min. Negotiated Rate |
$1,364.39 |
| Max. Negotiated Rate |
$4,385.54 |
| Rate for Payer: Cash Price |
$1,942.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,949.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,754.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,754.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,851.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,949.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,851.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,949.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,949.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,461.85
|
| Rate for Payer: Healthfirst Commercial |
$1,949.13
|
| Rate for Payer: Healthfirst Essential Plan |
$4,385.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,851.67
|
| Rate for Payer: Healthfirst QHP |
$1,949.13
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,364.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,949.13
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,656.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,364.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,949.13
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,461.85
|
| Rate for Payer: SOMOS Essential |
$1,461.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,949.13
|
|
|
PR LAMINECTOMY W/O FFD 1/2 VERT SEG LUMBAR
|
Professional
|
Both
|
$5,658.07
|
|
|
Service Code
|
HCPCS 63005
|
| Min. Negotiated Rate |
$1,051.42 |
| Max. Negotiated Rate |
$3,379.57 |
| Rate for Payer: Cash Price |
$1,506.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,502.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,351.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,351.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,426.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,502.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,426.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,502.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,502.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,126.52
|
| Rate for Payer: Healthfirst Commercial |
$1,502.03
|
| Rate for Payer: Healthfirst Essential Plan |
$3,379.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,426.93
|
| Rate for Payer: Healthfirst QHP |
$1,502.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,051.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,502.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,276.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,051.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,502.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,126.52
|
| Rate for Payer: SOMOS Essential |
$1,126.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,502.03
|
|
|
PR LAMINECTOMY W/O FFD 1/2 VERT SEG SACRAL
|
Professional
|
Both
|
$4,974.97
|
|
|
Service Code
|
HCPCS 63011
|
| Min. Negotiated Rate |
$919.02 |
| Max. Negotiated Rate |
$2,953.98 |
| Rate for Payer: Cash Price |
$1,324.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,312.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,181.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,181.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,247.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,312.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,247.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,312.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,312.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$984.66
|
| Rate for Payer: Healthfirst Commercial |
$1,312.88
|
| Rate for Payer: Healthfirst Essential Plan |
$2,953.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,247.24
|
| Rate for Payer: Healthfirst QHP |
$1,312.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$919.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,312.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,115.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$919.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,312.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$984.66
|
| Rate for Payer: SOMOS Essential |
$984.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,312.88
|
|
|
PR LAMINECTOMY W/O FFD 1/2 VERT SEG THORACIC
|
Professional
|
Both
|
$5,824.74
|
|
|
Service Code
|
HCPCS 63003
|
| Min. Negotiated Rate |
$1,079.30 |
| Max. Negotiated Rate |
$3,469.16 |
| Rate for Payer: Cash Price |
$1,546.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,541.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,387.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,387.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,464.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,541.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,464.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,541.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,541.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,156.39
|
| Rate for Payer: Healthfirst Commercial |
$1,541.85
|
| Rate for Payer: Healthfirst Essential Plan |
$3,469.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,464.76
|
| Rate for Payer: Healthfirst QHP |
$1,541.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,079.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,541.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,310.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,079.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,541.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,156.39
|
| Rate for Payer: SOMOS Essential |
$1,156.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,541.85
|
|
|
PR LAMINECTOMY W/O FFD > 2 VERT SEG CERVICAL
|
Professional
|
Both
|
$7,030.49
|
|
|
Service Code
|
HCPCS 63015
|
| Min. Negotiated Rate |
$1,297.25 |
| Max. Negotiated Rate |
$4,169.72 |
| Rate for Payer: Cash Price |
$1,864.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,853.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,667.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,667.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,760.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,853.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,760.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,853.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,853.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,389.91
|
| Rate for Payer: Healthfirst Commercial |
$1,853.21
|
| Rate for Payer: Healthfirst Essential Plan |
$4,169.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,760.55
|
| Rate for Payer: Healthfirst QHP |
$1,853.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,297.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,853.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,575.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,297.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,853.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,389.91
|
| Rate for Payer: SOMOS Essential |
$1,389.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,853.21
|
|
|
PR LAMINECTOMY W/O FFD > 2 VERT SEG LUMBAR
|
Professional
|
Both
|
$6,009.85
|
|
|
Service Code
|
HCPCS 63017
|
| Min. Negotiated Rate |
$1,108.45 |
| Max. Negotiated Rate |
$3,562.88 |
| Rate for Payer: Cash Price |
$1,593.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,583.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,425.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,425.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,504.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,583.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,504.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,583.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,583.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,187.62
|
| Rate for Payer: Healthfirst Commercial |
$1,583.50
|
| Rate for Payer: Healthfirst Essential Plan |
$3,562.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,504.33
|
| Rate for Payer: Healthfirst QHP |
$1,583.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,108.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,583.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,345.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,108.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,583.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,187.62
|
| Rate for Payer: SOMOS Essential |
$1,187.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,583.50
|
|
|
PR LAMINECTOMY W/O FFD > 2 VERT SEG THORACIC
|
Professional
|
Both
|
$7,238.74
|
|
|
Service Code
|
HCPCS 63016
|
| Min. Negotiated Rate |
$1,326.88 |
| Max. Negotiated Rate |
$4,264.97 |
| Rate for Payer: Cash Price |
$1,912.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,895.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,705.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,705.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,800.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,895.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,800.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,895.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,895.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,421.65
|
| Rate for Payer: Healthfirst Commercial |
$1,895.54
|
| Rate for Payer: Healthfirst Essential Plan |
$4,264.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,800.76
|
| Rate for Payer: Healthfirst QHP |
$1,895.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,326.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,895.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,611.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,326.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,895.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,421.65
|
| Rate for Payer: SOMOS Essential |
$1,421.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,895.54
|
|
|
PR LAMINECTOMY W/RHIZOTOMY 1/2 SEGMENTS
|
Professional
|
Both
|
$5,233.13
|
|
|
Service Code
|
HCPCS 63185
|
| Min. Negotiated Rate |
$1,087.98 |
| Max. Negotiated Rate |
$3,497.09 |
| Rate for Payer: Cash Price |
$1,565.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,554.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,398.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,398.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,476.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,554.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,476.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,554.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,554.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,165.69
|
| Rate for Payer: Healthfirst Commercial |
$1,554.26
|
| Rate for Payer: Healthfirst Essential Plan |
$3,497.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,476.55
|
| Rate for Payer: Healthfirst QHP |
$1,554.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,087.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,554.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,321.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,087.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,554.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,165.69
|
| Rate for Payer: SOMOS Essential |
$1,165.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,554.26
|
|
|
PR LAMINECTOMY W/RHIZOTOMY > 2 SEGMENTS
|
Professional
|
Both
|
$5,473.09
|
|
|
Service Code
|
HCPCS 63190
|
| Min. Negotiated Rate |
$1,027.66 |
| Max. Negotiated Rate |
$3,303.20 |
| Rate for Payer: Cash Price |
$1,475.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,468.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,321.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,321.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,394.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,468.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,394.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,468.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,468.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,101.07
|
| Rate for Payer: Healthfirst Commercial |
$1,468.09
|
| Rate for Payer: Healthfirst Essential Plan |
$3,303.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,394.69
|
| Rate for Payer: Healthfirst QHP |
$1,468.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,027.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,468.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,247.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,027.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,468.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,101.07
|
| Rate for Payer: SOMOS Essential |
$1,101.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,468.09
|
|
|
PR LAMINECTOMY W/RMVL ABNORMAL FACETS LUMBAR
|
Professional
|
Both
|
$5,606.93
|
|
|
Service Code
|
HCPCS 63012
|
| Min. Negotiated Rate |
$1,031.47 |
| Max. Negotiated Rate |
$3,315.44 |
| Rate for Payer: Cash Price |
$1,485.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,473.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,326.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,326.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,399.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,473.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,399.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,473.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,473.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,105.15
|
| Rate for Payer: Healthfirst Commercial |
$1,473.53
|
| Rate for Payer: Healthfirst Essential Plan |
$3,315.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,399.85
|
| Rate for Payer: Healthfirst QHP |
$1,473.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,031.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,473.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,252.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,031.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,473.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,105.15
|
| Rate for Payer: SOMOS Essential |
$1,105.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,473.53
|
|
|
PR LAMINECTOMY W/SECTION SPINAL ACCESSORY NERVE
|
Professional
|
Both
|
$6,659.38
|
|
|
Service Code
|
HCPCS 63191
|
| Min. Negotiated Rate |
$1,222.62 |
| Max. Negotiated Rate |
$3,929.85 |
| Rate for Payer: Cash Price |
$1,760.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,746.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,571.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,571.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,659.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,746.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,659.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,746.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,746.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,309.95
|
| Rate for Payer: Healthfirst Commercial |
$1,746.60
|
| Rate for Payer: Healthfirst Essential Plan |
$3,929.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,659.27
|
| Rate for Payer: Healthfirst QHP |
$1,746.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,222.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,746.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,484.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,222.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,746.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,309.95
|
| Rate for Payer: SOMOS Essential |
$1,309.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,746.60
|
|
|
PR LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC CERVC
|
Professional
|
Both
|
$5,090.65
|
|
|
Service Code
|
HCPCS 63020
|
| Min. Negotiated Rate |
$950.22 |
| Max. Negotiated Rate |
$3,054.28 |
| Rate for Payer: Cash Price |
$1,360.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,357.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,221.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,221.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,289.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,357.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,289.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,357.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,357.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,018.10
|
| Rate for Payer: Healthfirst Commercial |
$1,357.46
|
| Rate for Payer: Healthfirst Essential Plan |
$3,054.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,289.59
|
| Rate for Payer: Healthfirst QHP |
$1,357.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$950.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,357.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,153.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$950.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,357.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,018.10
|
| Rate for Payer: SOMOS Essential |
$1,018.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,357.46
|
|
