|
PR NERVE GRAFT MLT STRANDS ARM/LEG <4 CM
|
Professional
|
Both
|
$5,580.23
|
|
|
Service Code
|
HCPCS 64897
|
| Min. Negotiated Rate |
$1,045.60 |
| Max. Negotiated Rate |
$3,360.85 |
| Rate for Payer: Cash Price |
$1,500.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,493.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,344.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,344.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,419.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,493.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,419.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,493.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,493.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,120.28
|
| Rate for Payer: Healthfirst Commercial |
$1,493.71
|
| Rate for Payer: Healthfirst Essential Plan |
$3,360.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,419.02
|
| Rate for Payer: Healthfirst QHP |
$1,493.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,045.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,493.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,269.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,045.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,493.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,120.28
|
| Rate for Payer: SOMOS Essential |
$1,120.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,493.71
|
|
|
PR NERVE GRAFT MLT STRANDS ARM/LEG >4 CM
|
Professional
|
Both
|
$6,040.86
|
|
|
Service Code
|
HCPCS 64898
|
| Min. Negotiated Rate |
$1,132.45 |
| Max. Negotiated Rate |
$3,640.03 |
| Rate for Payer: Cash Price |
$1,625.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,617.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,456.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,456.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,536.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,617.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,536.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,617.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,617.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,213.34
|
| Rate for Payer: Healthfirst Commercial |
$1,617.79
|
| Rate for Payer: Healthfirst Essential Plan |
$3,640.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,536.90
|
| Rate for Payer: Healthfirst QHP |
$1,617.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,132.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,617.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,375.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,132.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,617.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,213.34
|
| Rate for Payer: SOMOS Essential |
$1,213.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,617.79
|
|
|
PR NERVE GRAFT MLT STRANDS HAND/FOOT <4 CM
|
Professional
|
Both
|
$5,843.11
|
|
|
Service Code
|
HCPCS 64895
|
| Min. Negotiated Rate |
$1,092.85 |
| Max. Negotiated Rate |
$3,512.72 |
| Rate for Payer: Cash Price |
$1,569.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,561.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,405.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,405.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,483.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,561.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,483.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,561.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,561.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,170.91
|
| Rate for Payer: Healthfirst Commercial |
$1,561.21
|
| Rate for Payer: Healthfirst Essential Plan |
$3,512.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,483.15
|
| Rate for Payer: Healthfirst QHP |
$1,561.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,092.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,561.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,327.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,092.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,561.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,170.91
|
| Rate for Payer: SOMOS Essential |
$1,170.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,561.21
|
|
|
PR NERVE GRAFT MLT STRANDS HAND/FOOT > 4 CM
|
Professional
|
Both
|
$6,290.17
|
|
|
Service Code
|
HCPCS 64896
|
| Min. Negotiated Rate |
$1,179.11 |
| Max. Negotiated Rate |
$3,789.99 |
| Rate for Payer: Cash Price |
$1,693.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,684.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,516.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,516.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,600.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,684.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,600.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,684.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,684.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,263.33
|
| Rate for Payer: Healthfirst Commercial |
$1,684.44
|
| Rate for Payer: Healthfirst Essential Plan |
$3,789.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,600.22
|
| Rate for Payer: Healthfirst QHP |
$1,684.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,179.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,684.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,431.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,179.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,684.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,263.33
|
| Rate for Payer: SOMOS Essential |
$1,263.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,684.44
|
|
|
PR NERVE PEDICAL TRANSFER SECOND STAGE
|
Professional
|
Both
|
$5,727.40
|
|
|
Service Code
|
HCPCS 64907
|
| Min. Negotiated Rate |
$1,072.17 |
| Max. Negotiated Rate |
$3,446.26 |
| Rate for Payer: Cash Price |
$1,540.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,531.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,378.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,378.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,455.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,531.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,455.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,531.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,531.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,148.75
|
| Rate for Payer: Healthfirst Commercial |
$1,531.67
|
| Rate for Payer: Healthfirst Essential Plan |
$3,446.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,455.09
|
| Rate for Payer: Healthfirst QHP |
$1,531.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,072.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,531.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,301.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,072.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,531.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,148.75
|
| Rate for Payer: SOMOS Essential |
$1,148.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,531.67
|
|
|
PR NERVE PEDICLE TRANSFER FIRST STAGE
|
Professional
|
Both
|
$4,411.82
|
|
|
Service Code
|
HCPCS 64905
|
| Min. Negotiated Rate |
$820.55 |
| Max. Negotiated Rate |
$2,637.49 |
| Rate for Payer: Cash Price |
$1,185.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,172.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,055.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,055.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,113.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,172.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,113.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,172.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,172.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$879.16
|
| Rate for Payer: Healthfirst Commercial |
$1,172.22
|
| Rate for Payer: Healthfirst Essential Plan |
$2,637.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,113.61
|
| Rate for Payer: Healthfirst QHP |
$1,172.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$820.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,172.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$996.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$820.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,172.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$879.16
|
| Rate for Payer: SOMOS Essential |
$879.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,172.22
|
|
|
PR NERVE REPAIR W/AUTOGENOUS VEIN GRAFT EA NERVE
|
Professional
|
Both
|
$4,515.88
|
|
|
Service Code
|
HCPCS 64911
|
| Min. Negotiated Rate |
$847.18 |
| Max. Negotiated Rate |
$2,723.09 |
| Rate for Payer: Cash Price |
$1,216.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,210.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,089.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,089.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,149.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,210.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,149.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,210.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,210.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$907.70
|
| Rate for Payer: Healthfirst Commercial |
$1,210.26
|
| Rate for Payer: Healthfirst Essential Plan |
$2,723.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,149.75
|
| Rate for Payer: Healthfirst QHP |
$1,210.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$847.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,210.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,028.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$847.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,210.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$907.70
|
| Rate for Payer: SOMOS Essential |
$907.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,210.26
|
|
|
PR NERVE REPAIR W/CONDUIT EACH NERVE
|
Professional
|
Both
|
$3,308.55
|
|
|
Service Code
|
HCPCS 64910
|
| Min. Negotiated Rate |
$625.56 |
| Max. Negotiated Rate |
$2,010.73 |
| Rate for Payer: Cash Price |
$898.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$893.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$804.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$804.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$848.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$893.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$848.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$893.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$893.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$670.25
|
| Rate for Payer: Healthfirst Commercial |
$893.66
|
| Rate for Payer: Healthfirst Essential Plan |
$2,010.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$848.98
|
| Rate for Payer: Healthfirst QHP |
$893.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$625.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$893.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$759.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$625.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$893.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$670.25
|
| Rate for Payer: SOMOS Essential |
$670.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$893.66
|
|
|
PR NERVE REPAIR W/NERVE ALLOGRAFT EA ADDL STRAND
|
Professional
|
Both
|
$750.75
|
|
|
Service Code
|
HCPCS 64913
|
| Min. Negotiated Rate |
$138.21 |
| Max. Negotiated Rate |
$444.24 |
| Rate for Payer: Cash Price |
$200.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$197.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$177.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$187.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$197.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$187.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.08
|
| Rate for Payer: Healthfirst Commercial |
$197.44
|
| Rate for Payer: Healthfirst Essential Plan |
$444.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$187.57
|
| Rate for Payer: Healthfirst QHP |
$197.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$197.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$167.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$197.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$148.08
|
| Rate for Payer: SOMOS Essential |
$148.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$197.44
|
|
|
PR NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND
|
Professional
|
Both
|
$3,923.82
|
|
|
Service Code
|
HCPCS 64912
|
| Min. Negotiated Rate |
$735.66 |
| Max. Negotiated Rate |
$2,364.61 |
| Rate for Payer: Cash Price |
$1,060.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,050.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$945.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$945.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$998.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,050.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$998.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,050.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,050.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$788.21
|
| Rate for Payer: Healthfirst Commercial |
$1,050.94
|
| Rate for Payer: Healthfirst Essential Plan |
$2,364.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$998.39
|
| Rate for Payer: Healthfirst QHP |
$1,050.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$735.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,050.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$893.30
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$735.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,050.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$788.21
|
| Rate for Payer: SOMOS Essential |
$788.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,050.94
|
|
|
PR NERVE TEASING PREPARATIONS
|
Professional
|
Both
|
$426.48
|
|
|
Service Code
|
HCPCS 88362 26
|
| Min. Negotiated Rate |
$81.66 |
| Max. Negotiated Rate |
$262.49 |
| Rate for Payer: Cash Price |
$118.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.50
|
| Rate for Payer: Healthfirst Commercial |
$116.66
|
| Rate for Payer: Healthfirst Essential Plan |
$262.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.83
|
| Rate for Payer: Healthfirst QHP |
$116.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.50
|
| Rate for Payer: SOMOS Essential |
$87.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.66
|
|
|
PR NERVE TEASING PREPARATIONS
|
Professional
|
Both
|
$521.26
|
|
|
Service Code
|
HCPCS 88362 TC
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$323.82 |
| Rate for Payer: Cash Price |
$144.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$143.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.94
|
| Rate for Payer: Healthfirst Commercial |
$143.92
|
| Rate for Payer: Healthfirst Essential Plan |
$323.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.72
|
| Rate for Payer: Healthfirst QHP |
$143.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$122.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.94
|
| Rate for Payer: SOMOS Essential |
$107.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.92
|
|
|
PR NERVE TEASING PREPARATIONS
|
Professional
|
Both
|
$947.73
|
|
|
Service Code
|
HCPCS 88362
|
| Min. Negotiated Rate |
$182.41 |
| Max. Negotiated Rate |
$586.30 |
| Rate for Payer: Cash Price |
$262.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$260.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$234.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$234.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$247.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$260.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$247.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$260.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$260.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$195.44
|
| Rate for Payer: Healthfirst Commercial |
$260.58
|
| Rate for Payer: Healthfirst Essential Plan |
$586.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$247.55
|
| Rate for Payer: Healthfirst QHP |
$260.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$182.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$260.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$221.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$182.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$260.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$195.44
|
| Rate for Payer: SOMOS Essential |
$195.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$260.58
|
|
|
PR NEURECTOMY HAMSTRING MUSCLE
|
Professional
|
Both
|
$2,513.21
|
|
|
Service Code
|
HCPCS 27325
|
| Min. Negotiated Rate |
$474.70 |
| Max. Negotiated Rate |
$1,525.84 |
| Rate for Payer: Cash Price |
$681.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$678.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$610.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$610.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$644.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$678.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$644.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$678.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$678.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$508.61
|
| Rate for Payer: Healthfirst Commercial |
$678.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,525.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$644.24
|
| Rate for Payer: Healthfirst QHP |
$678.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$474.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$678.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$576.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$474.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$678.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$508.61
|
| Rate for Payer: SOMOS Essential |
$508.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$678.15
|
|
|
PR NEURECTOMY INTRINSIC MUSCULATURE OF FOOT
|
Professional
|
Both
|
$1,606.05
|
|
|
Service Code
|
HCPCS 28055
|
| Min. Negotiated Rate |
$313.60 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Cash Price |
$450.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$448.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$403.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$403.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$425.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$448.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$425.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$448.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$448.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$336.00
|
| Rate for Payer: Healthfirst Commercial |
$448.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,008.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$425.60
|
| Rate for Payer: Healthfirst QHP |
$448.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$313.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$448.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$380.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$313.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$448.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$336.00
|
| Rate for Payer: SOMOS Essential |
$336.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$448.00
|
|
|
PR NEURECTOMY POPLITEAL
|
Professional
|
Both
|
$2,326.10
|
|
|
Service Code
|
HCPCS 27326
|
| Min. Negotiated Rate |
$440.88 |
| Max. Negotiated Rate |
$1,417.12 |
| Rate for Payer: Cash Price |
$631.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$629.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$566.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$566.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$598.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$629.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$598.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$629.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$629.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$472.37
|
| Rate for Payer: Healthfirst Commercial |
$629.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,417.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$598.34
|
| Rate for Payer: Healthfirst QHP |
$629.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$440.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$629.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$535.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$440.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$629.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$472.37
|
| Rate for Payer: SOMOS Essential |
$472.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$629.83
|
|
|
PR NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$316.65
|
|
|
Service Code
|
HCPCS 96116
|
| Min. Negotiated Rate |
$46.17 |
| Max. Negotiated Rate |
$191.45 |
| Rate for Payer: Amida Care Medicaid |
$46.17
|
| Rate for Payer: Cash Price |
$86.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.82
|
| Rate for Payer: Healthfirst Commercial |
$85.09
|
| Rate for Payer: Healthfirst Essential Plan |
$191.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.84
|
| Rate for Payer: Healthfirst QHP |
$85.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.82
|
| Rate for Payer: SOMOS Essential |
$63.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.09
|
|
|
PR NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR
|
Professional
|
Both
|
$258.20
|
|
|
Service Code
|
HCPCS 96121
|
| Min. Negotiated Rate |
$41.71 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Amida Care Medicaid |
$41.71
|
| Rate for Payer: Cash Price |
$70.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$69.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$69.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$69.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.44
|
| Rate for Payer: Healthfirst Commercial |
$69.92
|
| Rate for Payer: Healthfirst Essential Plan |
$157.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.42
|
| Rate for Payer: Healthfirst QHP |
$69.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$69.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$69.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.44
|
| Rate for Payer: SOMOS Essential |
$52.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.92
|
|
|
PR NEUROENDOSCOPY ICRA W/RETRIEVAL FOREIGN BODY
|
Professional
|
Both
|
$10,101.46
|
|
|
Service Code
|
HCPCS 62164
|
| Min. Negotiated Rate |
$1,848.83 |
| Max. Negotiated Rate |
$5,942.68 |
| Rate for Payer: Cash Price |
$2,665.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,641.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,377.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,377.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,509.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,641.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,509.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,641.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,641.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,980.89
|
| Rate for Payer: Healthfirst Commercial |
$2,641.19
|
| Rate for Payer: Healthfirst Essential Plan |
$5,942.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,509.13
|
| Rate for Payer: Healthfirst QHP |
$2,641.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,848.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,641.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,245.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,848.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,641.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,980.89
|
| Rate for Payer: SOMOS Essential |
$1,980.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,641.19
|
|
|
PR NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH
|
Professional
|
Both
|
$308.91
|
|
|
Service Code
|
HCPCS 95937 TC
|
| Min. Negotiated Rate |
$43.13 |
| Max. Negotiated Rate |
$177.82 |
| Rate for Payer: Amida Care Medicaid |
$43.13
|
| Rate for Payer: Cash Price |
$83.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.27
|
| Rate for Payer: Healthfirst Commercial |
$79.03
|
| Rate for Payer: Healthfirst Essential Plan |
$177.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.08
|
| Rate for Payer: Healthfirst QHP |
$79.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.32
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.27
|
| Rate for Payer: SOMOS Essential |
$59.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.03
|
|
|
PR NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH
|
Professional
|
Both
|
$138.36
|
|
|
Service Code
|
HCPCS 95937 26
|
| Min. Negotiated Rate |
$25.94 |
| Max. Negotiated Rate |
$83.39 |
| Rate for Payer: Amida Care Medicaid |
$43.13
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$37.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.80
|
| Rate for Payer: Healthfirst Commercial |
$37.06
|
| Rate for Payer: Healthfirst Essential Plan |
$83.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.21
|
| Rate for Payer: Healthfirst QHP |
$37.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$37.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$31.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.80
|
| Rate for Payer: SOMOS Essential |
$27.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37.06
|
|
|
PR NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH
|
Professional
|
Both
|
$447.27
|
|
|
Service Code
|
HCPCS 95937
|
| Min. Negotiated Rate |
$43.13 |
| Max. Negotiated Rate |
$261.18 |
| Rate for Payer: Amida Care Medicaid |
$43.13
|
| Rate for Payer: Cash Price |
$120.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$104.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$110.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$110.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.06
|
| Rate for Payer: Healthfirst Commercial |
$116.08
|
| Rate for Payer: Healthfirst Essential Plan |
$261.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.28
|
| Rate for Payer: Healthfirst QHP |
$116.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.06
|
| Rate for Payer: SOMOS Essential |
$87.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.08
|
|
|
PR NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT
|
Professional
|
Both
|
$2,253.72
|
|
|
Service Code
|
HCPCS 64702
|
| Min. Negotiated Rate |
$428.31 |
| Max. Negotiated Rate |
$1,376.71 |
| Rate for Payer: Cash Price |
$614.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$611.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$550.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$550.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$581.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$611.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$581.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$611.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$611.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$458.90
|
| Rate for Payer: Healthfirst Commercial |
$611.87
|
| Rate for Payer: Healthfirst Essential Plan |
$1,376.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$581.28
|
| Rate for Payer: Healthfirst QHP |
$611.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$428.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$611.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$520.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$428.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$611.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$458.90
|
| Rate for Payer: SOMOS Essential |
$458.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$611.87
|
|
|
PR NEUROPLASTY NERVE HAND/FOOT
|
Professional
|
Both
|
$1,379.18
|
|
|
Service Code
|
HCPCS 64704
|
| Min. Negotiated Rate |
$264.76 |
| Max. Negotiated Rate |
$851.02 |
| Rate for Payer: Cash Price |
$378.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$378.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$340.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$340.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$359.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$378.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$359.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$378.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$378.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$283.67
|
| Rate for Payer: Healthfirst Commercial |
$378.23
|
| Rate for Payer: Healthfirst Essential Plan |
$851.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$359.32
|
| Rate for Payer: Healthfirst QHP |
$378.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$264.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$378.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$321.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$264.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$378.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$283.67
|
| Rate for Payer: SOMOS Essential |
$283.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$378.23
|
|
|
PR NEUROPLASTY &/TRANSPOSITION CRANIAL NERVE
|
Professional
|
Both
|
$2,228.28
|
|
|
Service Code
|
HCPCS 64716
|
| Min. Negotiated Rate |
$419.11 |
| Max. Negotiated Rate |
$1,347.14 |
| Rate for Payer: Cash Price |
$605.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$598.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$538.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$538.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$568.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$598.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$568.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$598.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$598.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$449.05
|
| Rate for Payer: Healthfirst Commercial |
$598.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,347.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$568.79
|
| Rate for Payer: Healthfirst QHP |
$598.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$419.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$598.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$508.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$419.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$598.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$449.05
|
| Rate for Payer: SOMOS Essential |
$449.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$598.73
|
|
