|
PR NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION
|
Professional
|
Both
|
$679.70
|
|
|
Service Code
|
HCPCS 31240
|
| Min. Negotiated Rate |
$128.45 |
| Max. Negotiated Rate |
$412.88 |
| Rate for Payer: Cash Price |
$184.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$183.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$165.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$183.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$174.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$183.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$183.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.62
|
| Rate for Payer: Healthfirst Commercial |
$183.50
|
| Rate for Payer: Healthfirst Essential Plan |
$412.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$174.32
|
| Rate for Payer: Healthfirst QHP |
$183.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$183.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$155.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$183.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$137.62
|
| Rate for Payer: SOMOS Essential |
$137.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$183.50
|
|
|
PR NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMORRHAGE
|
Professional
|
Both
|
$713.09
|
|
|
Service Code
|
HCPCS 31238
|
| Min. Negotiated Rate |
$134.57 |
| Max. Negotiated Rate |
$432.56 |
| Rate for Payer: Cash Price |
$194.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$173.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$182.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.19
|
| Rate for Payer: Healthfirst Commercial |
$192.25
|
| Rate for Payer: Healthfirst Essential Plan |
$432.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$182.64
|
| Rate for Payer: Healthfirst QHP |
$192.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$192.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$163.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$144.19
|
| Rate for Payer: SOMOS Essential |
$144.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.25
|
|
|
PR NASAL/SINUS NDSC SURG W/DACRYOCYSTORHINOSTOMY
|
Professional
|
Both
|
$2,556.40
|
|
|
Service Code
|
HCPCS 31239
|
| Min. Negotiated Rate |
$485.00 |
| Max. Negotiated Rate |
$1,558.91 |
| Rate for Payer: Cash Price |
$697.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$692.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$623.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$623.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$658.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$692.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$658.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$692.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$692.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$519.64
|
| Rate for Payer: Healthfirst Commercial |
$692.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,558.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$658.21
|
| Rate for Payer: Healthfirst QHP |
$692.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$485.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$692.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$588.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$485.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$692.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$519.64
|
| Rate for Payer: SOMOS Essential |
$519.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$692.85
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION FRNT&SPHN SINUS
|
Professional
|
Both
|
$1,096.52
|
|
|
Service Code
|
HCPCS 31298
|
| Min. Negotiated Rate |
$204.13 |
| Max. Negotiated Rate |
$656.14 |
| Rate for Payer: Cash Price |
$295.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$291.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$262.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$262.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$277.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$291.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$277.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$291.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$218.72
|
| Rate for Payer: Healthfirst Commercial |
$291.62
|
| Rate for Payer: Healthfirst Essential Plan |
$656.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$277.04
|
| Rate for Payer: Healthfirst QHP |
$291.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$204.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$291.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$247.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$204.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$291.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$218.72
|
| Rate for Payer: SOMOS Essential |
$218.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$291.62
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS
|
Professional
|
Both
|
$767.41
|
|
|
Service Code
|
HCPCS 31296
|
| Min. Negotiated Rate |
$145.09 |
| Max. Negotiated Rate |
$466.36 |
| Rate for Payer: Cash Price |
$206.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$207.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$186.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$186.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$196.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$207.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$196.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.45
|
| Rate for Payer: Healthfirst Commercial |
$207.27
|
| Rate for Payer: Healthfirst Essential Plan |
$466.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.91
|
| Rate for Payer: Healthfirst QHP |
$207.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$145.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$207.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$176.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$145.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$207.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$155.45
|
| Rate for Payer: SOMOS Essential |
$155.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$207.27
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS
|
Professional
|
Both
|
$672.28
|
|
|
Service Code
|
HCPCS 31295
|
| Min. Negotiated Rate |
$126.82 |
| Max. Negotiated Rate |
$407.63 |
| Rate for Payer: Cash Price |
$182.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$181.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$163.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$181.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$181.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.88
|
| Rate for Payer: Healthfirst Commercial |
$181.17
|
| Rate for Payer: Healthfirst Essential Plan |
$407.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$172.11
|
| Rate for Payer: Healthfirst QHP |
$181.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$126.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$181.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$126.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$181.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.88
|
| Rate for Payer: SOMOS Essential |
$135.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$181.17
|
|
|
PR NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS
|
Professional
|
Both
|
$615.55
|
|
|
Service Code
|
HCPCS 31297
|
| Min. Negotiated Rate |
$115.72 |
| Max. Negotiated Rate |
$371.95 |
| Rate for Payer: Cash Price |
$166.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$148.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$148.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$157.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$157.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.98
|
| Rate for Payer: Healthfirst Commercial |
$165.31
|
| Rate for Payer: Healthfirst Essential Plan |
$371.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$157.04
|
| Rate for Payer: Healthfirst QHP |
$165.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$123.98
|
| Rate for Payer: SOMOS Essential |
$123.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.31
|
|
|
PR NASAL/SINUS NDSC SURG W/LIG SPHENOPALATINE ART
|
Professional
|
Both
|
$1,897.67
|
|
|
Service Code
|
HCPCS 31241
|
| Min. Negotiated Rate |
$354.51 |
| Max. Negotiated Rate |
$1,139.49 |
| Rate for Payer: Cash Price |
$513.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$506.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$455.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$455.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$481.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$506.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$481.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$506.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$506.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$379.83
|
| Rate for Payer: Healthfirst Commercial |
$506.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,139.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$481.12
|
| Rate for Payer: Healthfirst QHP |
$506.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$354.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$506.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$430.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$354.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$506.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$379.83
|
| Rate for Payer: SOMOS Essential |
$379.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$506.44
|
|
|
PR NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN
|
Professional
|
Both
|
$5,285.35
|
|
|
Service Code
|
HCPCS 31294
|
| Min. Negotiated Rate |
$984.16 |
| Max. Negotiated Rate |
$3,163.39 |
| Rate for Payer: Cash Price |
$1,424.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,405.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,265.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,265.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,335.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,405.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,335.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,405.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,405.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,054.46
|
| Rate for Payer: Healthfirst Commercial |
$1,405.95
|
| Rate for Payer: Healthfirst Essential Plan |
$3,163.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,335.65
|
| Rate for Payer: Healthfirst QHP |
$1,405.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$984.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,405.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,195.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$984.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,405.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,054.46
|
| Rate for Payer: SOMOS Essential |
$1,054.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,405.95
|
|
|
PR NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY
|
Professional
|
Both
|
$1,903.41
|
|
|
Service Code
|
HCPCS 31257
|
| Min. Negotiated Rate |
$355.70 |
| Max. Negotiated Rate |
$1,143.34 |
| Rate for Payer: Cash Price |
$513.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$508.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$457.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$457.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$482.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$508.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$482.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$508.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$508.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$381.11
|
| Rate for Payer: Healthfirst Commercial |
$508.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,143.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$482.74
|
| Rate for Payer: Healthfirst QHP |
$508.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$355.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$508.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$431.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$355.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$508.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$381.11
|
| Rate for Payer: SOMOS Essential |
$381.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$508.15
|
|
|
PR NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL
|
Professional
|
Both
|
$2,137.28
|
|
|
Service Code
|
HCPCS 31253
|
| Min. Negotiated Rate |
$398.81 |
| Max. Negotiated Rate |
$1,281.89 |
| Rate for Payer: Cash Price |
$575.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$569.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$512.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$512.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$541.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$569.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$541.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$569.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$569.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$427.30
|
| Rate for Payer: Healthfirst Commercial |
$569.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,281.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$541.24
|
| Rate for Payer: Healthfirst QHP |
$569.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$398.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$569.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$484.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$398.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$569.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$427.30
|
| Rate for Payer: SOMOS Essential |
$427.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$569.73
|
|
|
PR NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS RMVL
|
Professional
|
Both
|
$2,014.32
|
|
|
Service Code
|
HCPCS 31259
|
| Min. Negotiated Rate |
$376.88 |
| Max. Negotiated Rate |
$1,211.40 |
| Rate for Payer: Cash Price |
$542.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$538.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$484.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$484.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$511.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$538.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$511.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$538.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$538.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$403.80
|
| Rate for Payer: Healthfirst Commercial |
$538.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,211.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$511.48
|
| Rate for Payer: Healthfirst QHP |
$538.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$376.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$538.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$457.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$376.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$538.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$403.80
|
| Rate for Payer: SOMOS Essential |
$403.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$538.40
|
|
|
PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY
|
Professional
|
Both
|
$1,036.95
|
|
|
Service Code
|
HCPCS 31254
|
| Min. Negotiated Rate |
$194.57 |
| Max. Negotiated Rate |
$625.41 |
| Rate for Payer: Cash Price |
$280.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$277.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$250.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$250.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$277.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$277.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$277.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.47
|
| Rate for Payer: Healthfirst Commercial |
$277.96
|
| Rate for Payer: Healthfirst Essential Plan |
$625.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$264.06
|
| Rate for Payer: Healthfirst QHP |
$277.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$194.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$277.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$236.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$194.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$277.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$208.47
|
| Rate for Payer: SOMOS Essential |
$208.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$277.96
|
|
|
PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS
|
Professional
|
Both
|
$1,614.10
|
|
|
Service Code
|
HCPCS 31276
|
| Min. Negotiated Rate |
$302.18 |
| Max. Negotiated Rate |
$971.28 |
| Rate for Payer: Cash Price |
$436.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$431.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$388.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$388.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$431.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$431.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$431.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$323.76
|
| Rate for Payer: Healthfirst Commercial |
$431.68
|
| Rate for Payer: Healthfirst Essential Plan |
$971.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$410.10
|
| Rate for Payer: Healthfirst QHP |
$431.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$302.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$431.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$366.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$302.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$431.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$323.76
|
| Rate for Payer: SOMOS Essential |
$323.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$431.68
|
|
|
PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY
|
Professional
|
Both
|
$1,382.99
|
|
|
Service Code
|
HCPCS 31255
|
| Min. Negotiated Rate |
$258.10 |
| Max. Negotiated Rate |
$829.60 |
| Rate for Payer: Cash Price |
$372.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$368.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$331.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$331.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$350.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$368.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$350.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$368.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$368.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$276.53
|
| Rate for Payer: Healthfirst Commercial |
$368.71
|
| Rate for Payer: Healthfirst Essential Plan |
$829.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$350.27
|
| Rate for Payer: Healthfirst QHP |
$368.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$258.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$368.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$313.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$258.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$368.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$276.53
|
| Rate for Payer: SOMOS Essential |
$276.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$368.71
|
|
|
PR NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE
|
Professional
|
Both
|
$169.05
|
|
|
Service Code
|
HCPCS 43752
|
| Min. Negotiated Rate |
$31.46 |
| Max. Negotiated Rate |
$101.14 |
| Rate for Payer: Cash Price |
$45.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$44.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.71
|
| Rate for Payer: Healthfirst Commercial |
$44.95
|
| Rate for Payer: Healthfirst Essential Plan |
$101.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.70
|
| Rate for Payer: Healthfirst QHP |
$44.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$44.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$44.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.71
|
| Rate for Payer: SOMOS Essential |
$33.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$44.95
|
|
|
PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX
|
Professional
|
Both
|
$154.91
|
|
|
Service Code
|
HCPCS 92511
|
| Min. Negotiated Rate |
$29.76 |
| Max. Negotiated Rate |
$95.65 |
| Rate for Payer: Amida Care Medicaid |
$40.40
|
| Rate for Payer: Cash Price |
$42.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.88
|
| Rate for Payer: Healthfirst Commercial |
$42.51
|
| Rate for Payer: Healthfirst Essential Plan |
$95.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.38
|
| Rate for Payer: Healthfirst QHP |
$42.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.88
|
| Rate for Payer: SOMOS Essential |
$31.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.51
|
|
|
PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$200.17
|
|
|
Service Code
|
HCPCS 95860 26
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$122.76 |
| Rate for Payer: Amida Care Medicaid |
$66.93
|
| Rate for Payer: Cash Price |
$55.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$49.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$49.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.92
|
| Rate for Payer: Healthfirst Commercial |
$54.56
|
| Rate for Payer: Healthfirst Essential Plan |
$122.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.83
|
| Rate for Payer: Healthfirst QHP |
$54.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$38.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$46.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$38.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.92
|
| Rate for Payer: SOMOS Essential |
$40.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.56
|
|
|
PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$270.10
|
|
|
Service Code
|
HCPCS 95860 TC
|
| Min. Negotiated Rate |
$49.61 |
| Max. Negotiated Rate |
$159.46 |
| Rate for Payer: Amida Care Medicaid |
$66.93
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$67.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$53.15
|
| Rate for Payer: Healthfirst Commercial |
$70.87
|
| Rate for Payer: Healthfirst Essential Plan |
$159.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.33
|
| Rate for Payer: Healthfirst QHP |
$70.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$60.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$53.15
|
| Rate for Payer: SOMOS Essential |
$53.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.87
|
|
|
PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$470.30
|
|
|
Service Code
|
HCPCS 95860
|
| Min. Negotiated Rate |
$66.93 |
| Max. Negotiated Rate |
$282.24 |
| Rate for Payer: Amida Care Medicaid |
$66.93
|
| Rate for Payer: Cash Price |
$129.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$125.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.08
|
| Rate for Payer: Healthfirst Commercial |
$125.44
|
| Rate for Payer: Healthfirst Essential Plan |
$282.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.17
|
| Rate for Payer: Healthfirst QHP |
$125.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.08
|
| Rate for Payer: SOMOS Essential |
$94.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.44
|
|
|
PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$321.30
|
|
|
Service Code
|
HCPCS 95861 26
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$194.96 |
| Rate for Payer: Amida Care Medicaid |
$91.01
|
| Rate for Payer: Cash Price |
$88.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.99
|
| Rate for Payer: Healthfirst Commercial |
$86.65
|
| Rate for Payer: Healthfirst Essential Plan |
$194.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.32
|
| Rate for Payer: Healthfirst QHP |
$86.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.99
|
| Rate for Payer: SOMOS Essential |
$64.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.65
|
|
|
PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$670.46
|
|
|
Service Code
|
HCPCS 95861
|
| Min. Negotiated Rate |
$91.01 |
| Max. Negotiated Rate |
$391.97 |
| Rate for Payer: Amida Care Medicaid |
$91.01
|
| Rate for Payer: Cash Price |
$182.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$174.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$165.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$174.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$165.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.66
|
| Rate for Payer: Healthfirst Commercial |
$174.21
|
| Rate for Payer: Healthfirst Essential Plan |
$391.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$165.50
|
| Rate for Payer: Healthfirst QHP |
$174.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$174.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$148.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$174.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.66
|
| Rate for Payer: SOMOS Essential |
$130.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$174.21
|
|
|
PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$349.16
|
|
|
Service Code
|
HCPCS 95861 TC
|
| Min. Negotiated Rate |
$61.30 |
| Max. Negotiated Rate |
$197.03 |
| Rate for Payer: Amida Care Medicaid |
$91.01
|
| Rate for Payer: Cash Price |
$94.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$83.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$83.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.68
|
| Rate for Payer: Healthfirst Commercial |
$87.57
|
| Rate for Payer: Healthfirst Essential Plan |
$197.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$83.19
|
| Rate for Payer: Healthfirst QHP |
$87.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$61.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$61.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.68
|
| Rate for Payer: SOMOS Essential |
$65.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.57
|
|
|
PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$871.22
|
|
|
Service Code
|
HCPCS 95863
|
| Min. Negotiated Rate |
$109.08 |
| Max. Negotiated Rate |
$534.24 |
| Rate for Payer: Amida Care Medicaid |
$109.08
|
| Rate for Payer: Cash Price |
$237.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$237.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$213.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$225.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$237.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$225.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$237.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$178.08
|
| Rate for Payer: Healthfirst Commercial |
$237.44
|
| Rate for Payer: Healthfirst Essential Plan |
$534.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.57
|
| Rate for Payer: Healthfirst QHP |
$237.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$166.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$237.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$201.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$237.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$178.08
|
| Rate for Payer: SOMOS Essential |
$178.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$237.44
|
|
|
PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$391.23
|
|
|
Service Code
|
HCPCS 95863 26
|
| Min. Negotiated Rate |
$74.21 |
| Max. Negotiated Rate |
$238.52 |
| Rate for Payer: Amida Care Medicaid |
$109.08
|
| Rate for Payer: Cash Price |
$107.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$106.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$106.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.51
|
| Rate for Payer: Healthfirst Commercial |
$106.01
|
| Rate for Payer: Healthfirst Essential Plan |
$238.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$100.71
|
| Rate for Payer: Healthfirst QHP |
$106.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$74.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$106.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$90.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$74.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$106.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$79.51
|
| Rate for Payer: SOMOS Essential |
$79.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$106.01
|
|
