|
PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$479.99
|
|
|
Service Code
|
HCPCS 95863 TC
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$295.72 |
| Rate for Payer: Amida Care Medicaid |
$109.08
|
| Rate for Payer: Cash Price |
$130.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.57
|
| Rate for Payer: Healthfirst Commercial |
$131.43
|
| Rate for Payer: Healthfirst Essential Plan |
$295.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.86
|
| Rate for Payer: Healthfirst QHP |
$131.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.57
|
| Rate for Payer: SOMOS Essential |
$98.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.43
|
|
|
PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$560.49
|
|
|
Service Code
|
HCPCS 95864 TC
|
| Min. Negotiated Rate |
$96.89 |
| Max. Negotiated Rate |
$311.42 |
| Rate for Payer: Amida Care Medicaid |
$131.72
|
| Rate for Payer: Cash Price |
$151.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.81
|
| Rate for Payer: Healthfirst Commercial |
$138.41
|
| Rate for Payer: Healthfirst Essential Plan |
$311.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$131.49
|
| Rate for Payer: Healthfirst QHP |
$138.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$138.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.81
|
| Rate for Payer: SOMOS Essential |
$103.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.41
|
|
|
PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$418.92
|
|
|
Service Code
|
HCPCS 95864 26
|
| Min. Negotiated Rate |
$78.89 |
| Max. Negotiated Rate |
$253.57 |
| Rate for Payer: Amida Care Medicaid |
$131.72
|
| Rate for Payer: Cash Price |
$114.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.53
|
| Rate for Payer: Healthfirst Commercial |
$112.70
|
| Rate for Payer: Healthfirst Essential Plan |
$253.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.06
|
| Rate for Payer: Healthfirst QHP |
$112.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.53
|
| Rate for Payer: SOMOS Essential |
$84.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.70
|
|
|
PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS
|
Professional
|
Both
|
$979.41
|
|
|
Service Code
|
HCPCS 95864
|
| Min. Negotiated Rate |
$131.72 |
| Max. Negotiated Rate |
$565.02 |
| Rate for Payer: Amida Care Medicaid |
$131.72
|
| Rate for Payer: Cash Price |
$266.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$251.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$226.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$226.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$238.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$251.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$238.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.34
|
| Rate for Payer: Healthfirst Commercial |
$251.12
|
| Rate for Payer: Healthfirst Essential Plan |
$565.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$238.56
|
| Rate for Payer: Healthfirst QHP |
$251.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$175.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$251.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$213.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$175.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$251.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.34
|
| Rate for Payer: SOMOS Essential |
$188.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.12
|
|
|
PR NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ
|
Professional
|
Both
|
$430.64
|
|
|
Service Code
|
HCPCS 51785 26
|
| Min. Negotiated Rate |
$78.64 |
| Max. Negotiated Rate |
$252.76 |
| Rate for Payer: Cash Price |
$112.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.25
|
| Rate for Payer: Healthfirst Commercial |
$112.34
|
| Rate for Payer: Healthfirst Essential Plan |
$252.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.72
|
| Rate for Payer: Healthfirst QHP |
$112.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.25
|
| Rate for Payer: SOMOS Essential |
$84.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.34
|
|
|
PR NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ
|
Professional
|
Both
|
$1,495.87
|
|
|
Service Code
|
HCPCS 51785 TC
|
| Min. Negotiated Rate |
$246.38 |
| Max. Negotiated Rate |
$791.93 |
| Rate for Payer: Cash Price |
$408.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$351.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$316.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$316.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$334.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$351.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$334.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$351.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$351.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$263.98
|
| Rate for Payer: Healthfirst Commercial |
$351.97
|
| Rate for Payer: Healthfirst Essential Plan |
$791.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$334.37
|
| Rate for Payer: Healthfirst QHP |
$351.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$246.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$351.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$299.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$246.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$351.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$263.98
|
| Rate for Payer: SOMOS Essential |
$263.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$351.97
|
|
|
PR NDL EMG STDS EMG ANAL/URTL SPHNCTR ANY TQ
|
Professional
|
Both
|
$1,926.51
|
|
|
Service Code
|
HCPCS 51785
|
| Min. Negotiated Rate |
$325.02 |
| Max. Negotiated Rate |
$1,044.70 |
| Rate for Payer: Cash Price |
$520.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$464.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$417.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$417.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$441.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$464.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$441.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$464.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$464.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$348.23
|
| Rate for Payer: Healthfirst Commercial |
$464.31
|
| Rate for Payer: Healthfirst Essential Plan |
$1,044.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$441.09
|
| Rate for Payer: Healthfirst QHP |
$464.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$325.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$464.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$394.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$325.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$464.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$348.23
|
| Rate for Payer: SOMOS Essential |
$348.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$464.31
|
|
|
PR NDL OCULOELECTROMYOGRAPHY 1+EO MUSC 1/BOTH EYE
|
Professional
|
Both
|
$178.92
|
|
|
Service Code
|
HCPCS 92265 26
|
| Min. Negotiated Rate |
$34.36 |
| Max. Negotiated Rate |
$110.45 |
| Rate for Payer: Amida Care Medicaid |
$61.00
|
| Rate for Payer: Cash Price |
$49.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.82
|
| Rate for Payer: Healthfirst Commercial |
$49.09
|
| Rate for Payer: Healthfirst Essential Plan |
$110.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.64
|
| Rate for Payer: Healthfirst QHP |
$49.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.82
|
| Rate for Payer: SOMOS Essential |
$36.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.09
|
|
|
PR NDL OCULOELECTROMYOGRAPHY 1+EO MUSC 1/BOTH EYE
|
Professional
|
Both
|
$179.55
|
|
|
Service Code
|
HCPCS 92265 TC
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$110.56 |
| Rate for Payer: Amida Care Medicaid |
$61.00
|
| Rate for Payer: Cash Price |
$50.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.85
|
| Rate for Payer: Healthfirst Commercial |
$49.14
|
| Rate for Payer: Healthfirst Essential Plan |
$110.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.68
|
| Rate for Payer: Healthfirst QHP |
$49.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.85
|
| Rate for Payer: SOMOS Essential |
$36.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.14
|
|
|
PR NDL OCULOELECTROMYOGRAPHY 1+EO MUSC 1/BOTH EYE
|
Professional
|
Both
|
$358.47
|
|
|
Service Code
|
HCPCS 92265
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Amida Care Medicaid |
$61.00
|
| Rate for Payer: Cash Price |
$99.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.67
|
| Rate for Payer: Healthfirst Commercial |
$98.23
|
| Rate for Payer: Healthfirst Essential Plan |
$221.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.32
|
| Rate for Payer: Healthfirst QHP |
$98.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$83.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$68.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$73.67
|
| Rate for Payer: SOMOS Essential |
$73.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.23
|
|
|
PR NDSC ABLATION & RCNSTJ ATRIA EXTEN W/O BYPASS
|
Professional
|
Both
|
$8,162.25
|
|
|
Service Code
|
HCPCS 33266
|
| Min. Negotiated Rate |
$1,504.73 |
| Max. Negotiated Rate |
$4,836.65 |
| Rate for Payer: Cash Price |
$2,168.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,149.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,934.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,934.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,042.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,149.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,042.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,149.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,149.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,612.21
|
| Rate for Payer: Healthfirst Commercial |
$2,149.62
|
| Rate for Payer: Healthfirst Essential Plan |
$4,836.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,042.14
|
| Rate for Payer: Healthfirst QHP |
$2,149.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,504.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,149.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,827.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,504.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,149.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,612.21
|
| Rate for Payer: SOMOS Essential |
$1,612.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,149.62
|
|
|
PR NDSC ABLATION & RCNSTJ ATRIA LIMITED W/O BYPAS
|
Professional
|
Both
|
$6,034.81
|
|
|
Service Code
|
HCPCS 33265
|
| Min. Negotiated Rate |
$1,115.22 |
| Max. Negotiated Rate |
$3,584.63 |
| Rate for Payer: Cash Price |
$1,606.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,593.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,433.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,433.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,513.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,593.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,513.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,593.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,593.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,194.88
|
| Rate for Payer: Healthfirst Commercial |
$1,593.17
|
| Rate for Payer: Healthfirst Essential Plan |
$3,584.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,513.51
|
| Rate for Payer: Healthfirst QHP |
$1,593.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,115.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,593.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,354.19
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,115.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,593.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,194.88
|
| Rate for Payer: SOMOS Essential |
$1,194.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,593.17
|
|
|
PR NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX
|
Professional
|
Both
|
$311.68
|
|
|
Service Code
|
HCPCS 44385
|
| Min. Negotiated Rate |
$57.87 |
| Max. Negotiated Rate |
$186.01 |
| Rate for Payer: Cash Price |
$83.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.00
|
| Rate for Payer: Healthfirst Commercial |
$82.67
|
| Rate for Payer: Healthfirst Essential Plan |
$186.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.54
|
| Rate for Payer: Healthfirst QHP |
$82.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.00
|
| Rate for Payer: SOMOS Essential |
$62.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.67
|
|
|
PR NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$374.99
|
|
|
Service Code
|
HCPCS 44386
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$226.01 |
| Rate for Payer: Cash Price |
$101.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.34
|
| Rate for Payer: Healthfirst Commercial |
$100.45
|
| Rate for Payer: Healthfirst Essential Plan |
$226.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.43
|
| Rate for Payer: Healthfirst QHP |
$100.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.34
|
| Rate for Payer: SOMOS Essential |
$75.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.45
|
|
|
PR NDSC NJX IMPLT MATRL URT&/BLDR NCK
|
Professional
|
Both
|
$842.49
|
|
|
Service Code
|
HCPCS 51715
|
| Min. Negotiated Rate |
$158.48 |
| Max. Negotiated Rate |
$509.40 |
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$226.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$203.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.80
|
| Rate for Payer: Healthfirst Commercial |
$226.40
|
| Rate for Payer: Healthfirst Essential Plan |
$509.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.08
|
| Rate for Payer: Healthfirst QHP |
$226.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$226.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$226.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$169.80
|
| Rate for Payer: SOMOS Essential |
$169.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.40
|
|
|
PR NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG
|
Professional
|
Both
|
$70.91
|
|
|
Service Code
|
HCPCS 33508
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$41.62 |
| Rate for Payer: Cash Price |
$18.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.88
|
| Rate for Payer: Healthfirst Commercial |
$18.50
|
| Rate for Payer: Healthfirst Essential Plan |
$41.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.57
|
| Rate for Payer: Healthfirst QHP |
$18.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.88
|
| Rate for Payer: SOMOS Essential |
$13.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.50
|
|
|
PR NDSC URETEROTOMY RMVL FB/CALCULUS
|
Professional
|
Both
|
$1,473.50
|
|
|
Service Code
|
HCPCS 50980
|
| Min. Negotiated Rate |
$278.68 |
| Max. Negotiated Rate |
$895.75 |
| Rate for Payer: Cash Price |
$400.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$398.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$358.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$358.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$378.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$398.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$378.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$398.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$398.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$298.58
|
| Rate for Payer: Healthfirst Commercial |
$398.11
|
| Rate for Payer: Healthfirst Essential Plan |
$895.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$378.20
|
| Rate for Payer: Healthfirst QHP |
$398.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$278.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$398.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$338.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$278.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$398.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$298.58
|
| Rate for Payer: SOMOS Essential |
$298.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$398.11
|
|
|
PR NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER
|
Professional
|
Both
|
$1,481.38
|
|
|
Service Code
|
HCPCS 50972
|
| Min. Negotiated Rate |
$280.62 |
| Max. Negotiated Rate |
$901.98 |
| Rate for Payer: Cash Price |
$402.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$400.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$360.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$360.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$380.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$400.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$380.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$300.66
|
| Rate for Payer: Healthfirst Commercial |
$400.88
|
| Rate for Payer: Healthfirst Essential Plan |
$901.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$380.84
|
| Rate for Payer: Healthfirst QHP |
$400.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$280.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$400.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$340.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$280.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$400.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$300.66
|
| Rate for Payer: SOMOS Essential |
$300.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$400.88
|
|
|
PR NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM
|
Professional
|
Both
|
$2,261.56
|
|
|
Service Code
|
HCPCS 29848
|
| Min. Negotiated Rate |
$430.61 |
| Max. Negotiated Rate |
$1,384.09 |
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$615.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$553.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$553.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$584.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$615.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$584.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$615.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$615.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$461.36
|
| Rate for Payer: Healthfirst Commercial |
$615.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,384.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$584.39
|
| Rate for Payer: Healthfirst QHP |
$615.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$430.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$615.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$522.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$430.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$615.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$461.36
|
| Rate for Payer: SOMOS Essential |
$461.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$615.15
|
|
|
PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI
|
Professional
|
Both
|
$582.65
|
|
|
Service Code
|
HCPCS 95868
|
| Min. Negotiated Rate |
$75.21 |
| Max. Negotiated Rate |
$318.51 |
| Rate for Payer: Amida Care Medicaid |
$75.21
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.17
|
| Rate for Payer: Healthfirst Commercial |
$141.56
|
| Rate for Payer: Healthfirst Essential Plan |
$318.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.48
|
| Rate for Payer: Healthfirst QHP |
$141.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$120.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.17
|
| Rate for Payer: SOMOS Essential |
$106.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.56
|
|
|
PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI
|
Professional
|
Both
|
$243.57
|
|
|
Service Code
|
HCPCS 95868 26
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$148.54 |
| Rate for Payer: Amida Care Medicaid |
$75.21
|
| Rate for Payer: Cash Price |
$67.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.52
|
| Rate for Payer: Healthfirst Commercial |
$66.02
|
| Rate for Payer: Healthfirst Essential Plan |
$148.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.72
|
| Rate for Payer: Healthfirst QHP |
$66.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.52
|
| Rate for Payer: SOMOS Essential |
$49.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.02
|
|
|
PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI
|
Professional
|
Both
|
$339.12
|
|
|
Service Code
|
HCPCS 95868 TC
|
| Min. Negotiated Rate |
$52.87 |
| Max. Negotiated Rate |
$169.94 |
| Rate for Payer: Amida Care Medicaid |
$75.21
|
| Rate for Payer: Cash Price |
$91.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$75.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$71.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$75.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$75.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.65
|
| Rate for Payer: Healthfirst Commercial |
$75.53
|
| Rate for Payer: Healthfirst Essential Plan |
$169.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$71.75
|
| Rate for Payer: Healthfirst QHP |
$75.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$52.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$75.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$64.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$52.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$75.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$56.65
|
| Rate for Payer: SOMOS Essential |
$56.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$75.53
|
|
|
PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI
|
Professional
|
Both
|
$451.89
|
|
|
Service Code
|
HCPCS 95867
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$266.44 |
| Rate for Payer: Amida Care Medicaid |
$54.78
|
| Rate for Payer: Cash Price |
$123.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.81
|
| Rate for Payer: Healthfirst Commercial |
$118.42
|
| Rate for Payer: Healthfirst Essential Plan |
$266.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.50
|
| Rate for Payer: Healthfirst QHP |
$118.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.81
|
| Rate for Payer: SOMOS Essential |
$88.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.42
|
|
|
PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI
|
Professional
|
Both
|
$285.92
|
|
|
Service Code
|
HCPCS 95867 TC
|
| Min. Negotiated Rate |
$51.24 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Amida Care Medicaid |
$54.78
|
| Rate for Payer: Cash Price |
$77.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$73.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$65.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$73.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.90
|
| Rate for Payer: Healthfirst Commercial |
$73.20
|
| Rate for Payer: Healthfirst Essential Plan |
$164.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.54
|
| Rate for Payer: Healthfirst QHP |
$73.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$51.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$73.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$62.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$51.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$54.90
|
| Rate for Payer: SOMOS Essential |
$54.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.20
|
|
|
PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI
|
Professional
|
Both
|
$165.94
|
|
|
Service Code
|
HCPCS 95867 26
|
| Min. Negotiated Rate |
$31.65 |
| Max. Negotiated Rate |
$101.72 |
| Rate for Payer: Amida Care Medicaid |
$54.78
|
| Rate for Payer: Cash Price |
$45.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.91
|
| Rate for Payer: Healthfirst Commercial |
$45.21
|
| Rate for Payer: Healthfirst Essential Plan |
$101.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.95
|
| Rate for Payer: Healthfirst QHP |
$45.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$31.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$45.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$38.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$31.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$33.91
|
| Rate for Payer: SOMOS Essential |
$33.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.21
|
|
