|
PR NERVE CONDUCTION STUDIES 1-2 STUDIES
|
Professional
|
Both
|
$163.73
|
|
|
Service Code
|
HCPCS 95907 TC
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$96.59 |
| Rate for Payer: Amida Care Medicaid |
$59.95
|
| Rate for Payer: Cash Price |
$45.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.20
|
| Rate for Payer: Healthfirst Commercial |
$42.93
|
| Rate for Payer: Healthfirst Essential Plan |
$96.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.78
|
| Rate for Payer: Healthfirst QHP |
$42.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$30.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$42.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$36.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$30.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.20
|
| Rate for Payer: SOMOS Essential |
$32.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.93
|
|
|
PR NERVE CONDUCTION STUDIES 1-2 STUDIES
|
Professional
|
Both
|
$371.81
|
|
|
Service Code
|
HCPCS 95907
|
| Min. Negotiated Rate |
$59.95 |
| Max. Negotiated Rate |
$224.21 |
| Rate for Payer: Amida Care Medicaid |
$59.95
|
| Rate for Payer: Cash Price |
$102.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$99.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$94.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$99.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$94.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$99.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.74
|
| Rate for Payer: Healthfirst Commercial |
$99.65
|
| Rate for Payer: Healthfirst Essential Plan |
$224.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$94.67
|
| Rate for Payer: Healthfirst QHP |
$99.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$99.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$99.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.74
|
| Rate for Payer: SOMOS Essential |
$74.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$99.65
|
|
|
PR NERVE CONDUCTION STUDIES 13/> STUDIES
|
Professional
|
Both
|
$734.30
|
|
|
Service Code
|
HCPCS 95913 26
|
| Min. Negotiated Rate |
$140.43 |
| Max. Negotiated Rate |
$451.37 |
| Rate for Payer: Amida Care Medicaid |
$191.31
|
| Rate for Payer: Cash Price |
$201.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$200.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$180.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$190.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$200.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$190.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.46
|
| Rate for Payer: Healthfirst Commercial |
$200.61
|
| Rate for Payer: Healthfirst Essential Plan |
$451.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$190.58
|
| Rate for Payer: Healthfirst QHP |
$200.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$140.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$200.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$170.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$140.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$200.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$150.46
|
| Rate for Payer: SOMOS Essential |
$150.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.61
|
|
|
PR NERVE CONDUCTION STUDIES 13/> STUDIES
|
Professional
|
Both
|
$1,178.21
|
|
|
Service Code
|
HCPCS 95913
|
| Min. Negotiated Rate |
$191.31 |
| Max. Negotiated Rate |
$716.17 |
| Rate for Payer: Amida Care Medicaid |
$191.31
|
| Rate for Payer: Cash Price |
$323.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$318.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$286.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$302.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$318.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$302.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$238.72
|
| Rate for Payer: Healthfirst Commercial |
$318.30
|
| Rate for Payer: Healthfirst Essential Plan |
$716.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$302.38
|
| Rate for Payer: Healthfirst QHP |
$318.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$222.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$318.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$270.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$222.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$318.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$238.72
|
| Rate for Payer: SOMOS Essential |
$238.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$318.30
|
|
|
PR NERVE CONDUCTION STUDIES 13/> STUDIES
|
Professional
|
Both
|
$443.91
|
|
|
Service Code
|
HCPCS 95913 TC
|
| Min. Negotiated Rate |
$82.38 |
| Max. Negotiated Rate |
$264.78 |
| Rate for Payer: Amida Care Medicaid |
$191.31
|
| Rate for Payer: Cash Price |
$121.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$117.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$117.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.26
|
| Rate for Payer: Healthfirst Commercial |
$117.68
|
| Rate for Payer: Healthfirst Essential Plan |
$264.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.80
|
| Rate for Payer: Healthfirst QHP |
$117.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$117.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$117.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.26
|
| Rate for Payer: SOMOS Essential |
$88.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$117.68
|
|
|
PR NERVE CONDUCTION STUDIES 3-4 STUDIES
|
Professional
|
Both
|
$460.60
|
|
|
Service Code
|
HCPCS 95908
|
| Min. Negotiated Rate |
$73.95 |
| Max. Negotiated Rate |
$278.50 |
| Rate for Payer: Amida Care Medicaid |
$73.95
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$123.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$111.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$111.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$117.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$117.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.83
|
| Rate for Payer: Healthfirst Commercial |
$123.78
|
| Rate for Payer: Healthfirst Essential Plan |
$278.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$117.59
|
| Rate for Payer: Healthfirst QHP |
$123.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$86.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$123.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$86.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$123.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.83
|
| Rate for Payer: SOMOS Essential |
$92.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$123.78
|
|
|
PR NERVE CONDUCTION STUDIES 3-4 STUDIES
|
Professional
|
Both
|
$258.06
|
|
|
Service Code
|
HCPCS 95908 26
|
| Min. Negotiated Rate |
$49.27 |
| Max. Negotiated Rate |
$158.35 |
| Rate for Payer: Amida Care Medicaid |
$73.95
|
| Rate for Payer: Cash Price |
$71.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.78
|
| Rate for Payer: Healthfirst Commercial |
$70.38
|
| Rate for Payer: Healthfirst Essential Plan |
$158.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.86
|
| Rate for Payer: Healthfirst QHP |
$70.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.78
|
| Rate for Payer: SOMOS Essential |
$52.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.38
|
|
|
PR NERVE CONDUCTION STUDIES 3-4 STUDIES
|
Professional
|
Both
|
$202.55
|
|
|
Service Code
|
HCPCS 95908 TC
|
| Min. Negotiated Rate |
$37.39 |
| Max. Negotiated Rate |
$120.17 |
| Rate for Payer: Amida Care Medicaid |
$73.95
|
| Rate for Payer: Cash Price |
$55.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.06
|
| Rate for Payer: Healthfirst Commercial |
$53.41
|
| Rate for Payer: Healthfirst Essential Plan |
$120.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.74
|
| Rate for Payer: Healthfirst QHP |
$53.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.06
|
| Rate for Payer: SOMOS Essential |
$40.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.41
|
|
|
PR NERVE CONDUCTION STUDIES 5-6 STUDIES
|
Professional
|
Both
|
$312.10
|
|
|
Service Code
|
HCPCS 95909 26
|
| Min. Negotiated Rate |
$59.26 |
| Max. Negotiated Rate |
$190.46 |
| Rate for Payer: Amida Care Medicaid |
$88.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.49
|
| Rate for Payer: Healthfirst Commercial |
$84.65
|
| Rate for Payer: Healthfirst Essential Plan |
$190.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.42
|
| Rate for Payer: Healthfirst QHP |
$84.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.49
|
| Rate for Payer: SOMOS Essential |
$63.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.65
|
|
|
PR NERVE CONDUCTION STUDIES 5-6 STUDIES
|
Professional
|
Both
|
$242.80
|
|
|
Service Code
|
HCPCS 95909 TC
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.63 |
| Rate for Payer: Amida Care Medicaid |
$88.61
|
| Rate for Payer: Cash Price |
$67.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.21
|
| Rate for Payer: Healthfirst Commercial |
$64.28
|
| Rate for Payer: Healthfirst Essential Plan |
$144.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.07
|
| Rate for Payer: Healthfirst QHP |
$64.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.21
|
| Rate for Payer: SOMOS Essential |
$48.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.28
|
|
|
PR NERVE CONDUCTION STUDIES 5-6 STUDIES
|
Professional
|
Both
|
$554.89
|
|
|
Service Code
|
HCPCS 95909
|
| Min. Negotiated Rate |
$88.61 |
| Max. Negotiated Rate |
$335.09 |
| Rate for Payer: Amida Care Medicaid |
$88.61
|
| Rate for Payer: Cash Price |
$152.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$148.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$148.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.70
|
| Rate for Payer: Healthfirst Commercial |
$148.93
|
| Rate for Payer: Healthfirst Essential Plan |
$335.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.48
|
| Rate for Payer: Healthfirst QHP |
$148.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$148.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$126.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$148.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.70
|
| Rate for Payer: SOMOS Essential |
$111.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$148.93
|
|
|
PR NERVE CONDUCTION STUDIES 7-8 STUDIES
|
Professional
|
Both
|
$414.68
|
|
|
Service Code
|
HCPCS 95910 26
|
| Min. Negotiated Rate |
$78.97 |
| Max. Negotiated Rate |
$253.84 |
| Rate for Payer: Amida Care Medicaid |
$116.60
|
| Rate for Payer: Cash Price |
$114.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.61
|
| Rate for Payer: Healthfirst Commercial |
$112.82
|
| Rate for Payer: Healthfirst Essential Plan |
$253.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.18
|
| Rate for Payer: Healthfirst QHP |
$112.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.90
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.61
|
| Rate for Payer: SOMOS Essential |
$84.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.82
|
|
|
PR NERVE CONDUCTION STUDIES 7-8 STUDIES
|
Professional
|
Both
|
$310.35
|
|
|
Service Code
|
HCPCS 95910 TC
|
| Min. Negotiated Rate |
$57.22 |
| Max. Negotiated Rate |
$183.91 |
| Rate for Payer: Amida Care Medicaid |
$116.60
|
| Rate for Payer: Cash Price |
$85.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.30
|
| Rate for Payer: Healthfirst Commercial |
$81.74
|
| Rate for Payer: Healthfirst Essential Plan |
$183.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.65
|
| Rate for Payer: Healthfirst QHP |
$81.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$57.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$69.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$57.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61.30
|
| Rate for Payer: SOMOS Essential |
$61.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.74
|
|
|
PR NERVE CONDUCTION STUDIES 7-8 STUDIES
|
Professional
|
Both
|
$725.06
|
|
|
Service Code
|
HCPCS 95910
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$437.76 |
| Rate for Payer: Amida Care Medicaid |
$116.60
|
| Rate for Payer: Cash Price |
$199.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$194.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$175.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$184.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$194.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$184.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.92
|
| Rate for Payer: Healthfirst Commercial |
$194.56
|
| Rate for Payer: Healthfirst Essential Plan |
$437.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$184.83
|
| Rate for Payer: Healthfirst QHP |
$194.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$194.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$165.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$194.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$145.92
|
| Rate for Payer: SOMOS Essential |
$145.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$194.56
|
|
|
PR NERVE CONDUCTION STUDIES 9-10 STUDIES
|
Professional
|
Both
|
$517.30
|
|
|
Service Code
|
HCPCS 95911 26
|
| Min. Negotiated Rate |
$98.85 |
| Max. Negotiated Rate |
$317.72 |
| Rate for Payer: Amida Care Medicaid |
$141.09
|
| Rate for Payer: Cash Price |
$142.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$141.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$127.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$134.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$141.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$134.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.91
|
| Rate for Payer: Healthfirst Commercial |
$141.21
|
| Rate for Payer: Healthfirst Essential Plan |
$317.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$134.15
|
| Rate for Payer: Healthfirst QHP |
$141.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$141.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$120.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$141.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.91
|
| Rate for Payer: SOMOS Essential |
$105.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$141.21
|
|
|
PR NERVE CONDUCTION STUDIES 9-10 STUDIES
|
Professional
|
Both
|
$356.37
|
|
|
Service Code
|
HCPCS 95911 TC
|
| Min. Negotiated Rate |
$64.55 |
| Max. Negotiated Rate |
$207.50 |
| Rate for Payer: Amida Care Medicaid |
$141.09
|
| Rate for Payer: Cash Price |
$97.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$92.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$83.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$83.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$87.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$92.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$92.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$92.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.17
|
| Rate for Payer: Healthfirst Commercial |
$92.22
|
| Rate for Payer: Healthfirst Essential Plan |
$207.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.61
|
| Rate for Payer: Healthfirst QHP |
$92.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$92.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$78.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$92.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$69.17
|
| Rate for Payer: SOMOS Essential |
$69.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$92.22
|
|
|
PR NERVE CONDUCTION STUDIES 9-10 STUDIES
|
Professional
|
Both
|
$873.64
|
|
|
Service Code
|
HCPCS 95911
|
| Min. Negotiated Rate |
$141.09 |
| Max. Negotiated Rate |
$525.24 |
| Rate for Payer: Amida Care Medicaid |
$141.09
|
| Rate for Payer: Cash Price |
$240.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$233.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$210.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$221.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$233.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$221.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.08
|
| Rate for Payer: Healthfirst Commercial |
$233.44
|
| Rate for Payer: Healthfirst Essential Plan |
$525.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$221.77
|
| Rate for Payer: Healthfirst QHP |
$233.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$163.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$233.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$198.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$163.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$233.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$175.08
|
| Rate for Payer: SOMOS Essential |
$175.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$233.44
|
|
|
PR NERVE GRAFT 1 STRAND ARM/LEG <4 CM
|
Professional
|
Both
|
$4,638.38
|
|
|
Service Code
|
HCPCS 64892
|
| Min. Negotiated Rate |
$868.26 |
| Max. Negotiated Rate |
$2,790.83 |
| Rate for Payer: Cash Price |
$1,248.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,240.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,116.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,116.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,178.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,240.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,178.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,240.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,240.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$930.28
|
| Rate for Payer: Healthfirst Commercial |
$1,240.37
|
| Rate for Payer: Healthfirst Essential Plan |
$2,790.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,178.35
|
| Rate for Payer: Healthfirst QHP |
$1,240.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$868.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,240.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,054.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$868.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,240.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$930.28
|
| Rate for Payer: SOMOS Essential |
$930.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,240.37
|
|
|
PR NERVE GRAFT 1 STRAND ARM/LEG >4 CM
|
Professional
|
Both
|
$4,942.18
|
|
|
Service Code
|
HCPCS 64893
|
| Min. Negotiated Rate |
$926.00 |
| Max. Negotiated Rate |
$2,976.43 |
| Rate for Payer: Cash Price |
$1,330.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,322.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,190.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,190.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,256.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,322.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,256.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,322.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,322.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$992.14
|
| Rate for Payer: Healthfirst Commercial |
$1,322.86
|
| Rate for Payer: Healthfirst Essential Plan |
$2,976.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,256.72
|
| Rate for Payer: Healthfirst QHP |
$1,322.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$926.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,322.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,124.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$926.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,322.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$992.14
|
| Rate for Payer: SOMOS Essential |
$992.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,322.86
|
|
|
PR NERVE GRAFT 1 STRAND HAND/FOOT <4 CM
|
Professional
|
Both
|
$4,763.01
|
|
|
Service Code
|
HCPCS 64890
|
| Min. Negotiated Rate |
$892.41 |
| Max. Negotiated Rate |
$2,868.46 |
| Rate for Payer: Cash Price |
$1,282.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,274.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,147.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,147.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,211.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,274.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,211.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,274.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,274.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$956.15
|
| Rate for Payer: Healthfirst Commercial |
$1,274.87
|
| Rate for Payer: Healthfirst Essential Plan |
$2,868.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,211.13
|
| Rate for Payer: Healthfirst QHP |
$1,274.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$892.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,274.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,083.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$892.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,274.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$956.15
|
| Rate for Payer: SOMOS Essential |
$956.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,274.87
|
|
|
PR NERVE GRAFT 1 STRAND HAND/FOOT >4 CM
|
Professional
|
Both
|
$5,062.86
|
|
|
Service Code
|
HCPCS 64891
|
| Min. Negotiated Rate |
$948.70 |
| Max. Negotiated Rate |
$3,049.38 |
| Rate for Payer: Cash Price |
$1,363.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,355.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,219.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,219.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,287.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,355.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,287.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,355.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,355.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,016.46
|
| Rate for Payer: Healthfirst Commercial |
$1,355.28
|
| Rate for Payer: Healthfirst Essential Plan |
$3,049.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,287.52
|
| Rate for Payer: Healthfirst QHP |
$1,355.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$948.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,355.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,151.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$948.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,355.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,016.46
|
| Rate for Payer: SOMOS Essential |
$1,016.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,355.28
|
|
|
PR NERVE GRAFT EACH NERVE 1 STRAND
|
Professional
|
Both
|
$2,598.89
|
|
|
Service Code
|
HCPCS 64901
|
| Min. Negotiated Rate |
$483.56 |
| Max. Negotiated Rate |
$1,554.30 |
| Rate for Payer: Cash Price |
$694.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$690.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$621.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$621.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$656.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$690.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$656.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$690.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$690.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$518.10
|
| Rate for Payer: Healthfirst Commercial |
$690.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,554.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$656.26
|
| Rate for Payer: Healthfirst QHP |
$690.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$483.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$690.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$587.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$483.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$690.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$518.10
|
| Rate for Payer: SOMOS Essential |
$518.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$690.80
|
|
|
PR NERVE GRAFT EACH NERVE MULTIPLE STRANDS
|
Professional
|
Both
|
$3,011.58
|
|
|
Service Code
|
HCPCS 64902
|
| Min. Negotiated Rate |
$559.16 |
| Max. Negotiated Rate |
$1,797.30 |
| Rate for Payer: Cash Price |
$803.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$798.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$718.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$718.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$758.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$798.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$758.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$798.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$798.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$599.10
|
| Rate for Payer: Healthfirst Commercial |
$798.80
|
| Rate for Payer: Healthfirst Essential Plan |
$1,797.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$758.86
|
| Rate for Payer: Healthfirst QHP |
$798.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$559.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$798.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$678.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$559.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$798.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$599.10
|
| Rate for Payer: SOMOS Essential |
$599.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$798.80
|
|
|
PR NERVE GRAFT HEAD/NECK <4 CM
|
Professional
|
Both
|
$4,610.80
|
|
|
Service Code
|
HCPCS 64885
|
| Min. Negotiated Rate |
$865.96 |
| Max. Negotiated Rate |
$2,783.45 |
| Rate for Payer: Cash Price |
$1,249.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,237.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,113.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,113.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,175.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,237.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,175.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,237.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,237.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$927.82
|
| Rate for Payer: Healthfirst Commercial |
$1,237.09
|
| Rate for Payer: Healthfirst Essential Plan |
$2,783.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,175.24
|
| Rate for Payer: Healthfirst QHP |
$1,237.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$865.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,237.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,051.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$865.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,237.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$927.82
|
| Rate for Payer: SOMOS Essential |
$927.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,237.09
|
|
|
PR NERVE GRAFT HEAD/NECK >4 CM
|
Professional
|
Both
|
$5,555.17
|
|
|
Service Code
|
HCPCS 64886
|
| Min. Negotiated Rate |
$1,039.79 |
| Max. Negotiated Rate |
$3,342.17 |
| Rate for Payer: Cash Price |
$1,499.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,485.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,336.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,336.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,411.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,485.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,411.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,485.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,485.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,114.06
|
| Rate for Payer: Healthfirst Commercial |
$1,485.41
|
| Rate for Payer: Healthfirst Essential Plan |
$3,342.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,411.14
|
| Rate for Payer: Healthfirst QHP |
$1,485.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,039.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,485.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,262.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,039.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,485.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,114.06
|
| Rate for Payer: SOMOS Essential |
$1,114.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,485.41
|
|
