|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW
|
Professional
|
Both
|
$2,670.22
|
|
|
Service Code
|
HCPCS 64718
|
| Min. Negotiated Rate |
$506.69 |
| Max. Negotiated Rate |
$1,628.66 |
| Rate for Payer: Cash Price |
$725.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$723.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$651.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$651.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$687.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$723.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$687.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$723.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$723.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$542.89
|
| Rate for Payer: Healthfirst Commercial |
$723.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,628.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$687.66
|
| Rate for Payer: Healthfirst QHP |
$723.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$506.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$723.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$615.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$506.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$723.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$542.89
|
| Rate for Payer: SOMOS Essential |
$542.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$723.85
|
|
|
PR NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST
|
Professional
|
Both
|
$1,801.10
|
|
|
Service Code
|
HCPCS 64719
|
| Min. Negotiated Rate |
$341.64 |
| Max. Negotiated Rate |
$1,098.13 |
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$439.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$463.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$463.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$488.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$488.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$366.05
|
| Rate for Payer: Healthfirst Commercial |
$488.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,098.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$463.66
|
| Rate for Payer: Healthfirst QHP |
$488.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$341.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$488.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$414.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$341.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$366.05
|
| Rate for Payer: SOMOS Essential |
$366.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.06
|
|
|
PR NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE
|
Professional
|
Both
|
$1,931.51
|
|
|
Service Code
|
HCPCS 64721
|
| Min. Negotiated Rate |
$367.28 |
| Max. Negotiated Rate |
$1,180.55 |
| Rate for Payer: Cash Price |
$526.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$524.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$472.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$472.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$498.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$524.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$498.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$524.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$524.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$393.52
|
| Rate for Payer: Healthfirst Commercial |
$524.69
|
| Rate for Payer: Healthfirst Essential Plan |
$1,180.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$498.46
|
| Rate for Payer: Healthfirst QHP |
$524.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$367.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$524.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$445.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$367.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$524.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$393.52
|
| Rate for Payer: SOMOS Essential |
$393.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$524.69
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$415.56
|
|
|
Service Code
|
HCPCS 96132
|
| Min. Negotiated Rate |
$57.09 |
| Max. Negotiated Rate |
$257.76 |
| Rate for Payer: Amida Care Medicaid |
$57.09
|
| Rate for Payer: Cash Price |
$114.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$114.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$114.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.92
|
| Rate for Payer: Healthfirst Commercial |
$114.56
|
| Rate for Payer: Healthfirst Essential Plan |
$257.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.83
|
| Rate for Payer: Healthfirst QHP |
$114.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$114.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$114.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.92
|
| Rate for Payer: SOMOS Essential |
$85.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$114.56
|
|
|
PR NEUROPSYCHOLOGICAL TST EVAL PHYS/QHP EA ADDL HR
|
Professional
|
Both
|
$293.79
|
|
|
Service Code
|
HCPCS 96133
|
| Min. Negotiated Rate |
$43.76 |
| Max. Negotiated Rate |
$179.32 |
| Rate for Payer: Amida Care Medicaid |
$43.76
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.77
|
| Rate for Payer: Healthfirst Commercial |
$79.70
|
| Rate for Payer: Healthfirst Essential Plan |
$179.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.72
|
| Rate for Payer: Healthfirst QHP |
$79.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.77
|
| Rate for Payer: SOMOS Essential |
$59.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.70
|
|
|
PR NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC
|
Professional
|
Both
|
$2,186.31
|
|
|
Service Code
|
HCPCS 64708
|
| Min. Negotiated Rate |
$416.79 |
| Max. Negotiated Rate |
$1,339.69 |
| Rate for Payer: Cash Price |
$603.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$595.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$535.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$535.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$565.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$595.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$565.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$595.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$595.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$446.56
|
| Rate for Payer: Healthfirst Commercial |
$595.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,339.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$565.65
|
| Rate for Payer: Healthfirst QHP |
$595.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$416.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$595.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$506.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$416.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$595.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$446.56
|
| Rate for Payer: SOMOS Essential |
$446.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$595.42
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS
|
Professional
|
Both
|
$3,568.99
|
|
|
Service Code
|
HCPCS 64713
|
| Min. Negotiated Rate |
$671.22 |
| Max. Negotiated Rate |
$2,157.50 |
| Rate for Payer: Cash Price |
$967.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$958.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$863.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$863.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$910.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$958.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$910.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$958.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$958.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$719.17
|
| Rate for Payer: Healthfirst Commercial |
$958.89
|
| Rate for Payer: Healthfirst Essential Plan |
$2,157.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$910.95
|
| Rate for Payer: Healthfirst QHP |
$958.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$671.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$958.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$815.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$671.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$958.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$719.17
|
| Rate for Payer: SOMOS Essential |
$719.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$958.89
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS
|
Professional
|
Both
|
$3,384.01
|
|
|
Service Code
|
HCPCS 64714
|
| Min. Negotiated Rate |
$644.29 |
| Max. Negotiated Rate |
$2,070.95 |
| Rate for Payer: Cash Price |
$923.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$920.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$828.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$828.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$874.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$920.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$874.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$920.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$920.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$690.32
|
| Rate for Payer: Healthfirst Commercial |
$920.42
|
| Rate for Payer: Healthfirst Essential Plan |
$2,070.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$874.40
|
| Rate for Payer: Healthfirst QHP |
$920.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$644.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$920.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$782.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$644.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$920.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$690.32
|
| Rate for Payer: SOMOS Essential |
$690.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$920.42
|
|
|
PR NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV
|
Professional
|
Both
|
$2,632.63
|
|
|
Service Code
|
HCPCS 64712
|
| Min. Negotiated Rate |
$496.24 |
| Max. Negotiated Rate |
$1,595.05 |
| Rate for Payer: Cash Price |
$713.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$708.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$638.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$638.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$673.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$708.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$673.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$708.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$708.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$531.68
|
| Rate for Payer: Healthfirst Commercial |
$708.91
|
| Rate for Payer: Healthfirst Essential Plan |
$1,595.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$673.46
|
| Rate for Payer: Healthfirst QHP |
$708.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$496.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$708.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$602.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$496.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$708.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$531.68
|
| Rate for Payer: SOMOS Essential |
$531.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$708.91
|
|
|
PR N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI
|
Professional
|
Both
|
$100.59
|
|
|
Service Code
|
HCPCS 93924 26
|
| Min. Negotiated Rate |
$18.30 |
| Max. Negotiated Rate |
$187.93 |
| Rate for Payer: Amida Care Medicaid |
$187.93
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.61
|
| Rate for Payer: Healthfirst Commercial |
$26.14
|
| Rate for Payer: Healthfirst Essential Plan |
$58.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.83
|
| Rate for Payer: Healthfirst QHP |
$26.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$26.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.61
|
| Rate for Payer: SOMOS Essential |
$19.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.14
|
|
|
PR N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI
|
Professional
|
Both
|
$581.63
|
|
|
Service Code
|
HCPCS 93924 TC
|
| Min. Negotiated Rate |
$111.07 |
| Max. Negotiated Rate |
$357.01 |
| Rate for Payer: Amida Care Medicaid |
$187.93
|
| Rate for Payer: Cash Price |
$161.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$158.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$142.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$150.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$158.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$119.00
|
| Rate for Payer: Healthfirst Commercial |
$158.67
|
| Rate for Payer: Healthfirst Essential Plan |
$357.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.74
|
| Rate for Payer: Healthfirst QHP |
$158.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$111.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$158.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$134.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$111.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$158.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$119.00
|
| Rate for Payer: SOMOS Essential |
$119.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.67
|
|
|
PR N-INVAS PHYSIOLOGIC STD LXTR ART COMPL BI
|
Professional
|
Both
|
$682.22
|
|
|
Service Code
|
HCPCS 93924
|
| Min. Negotiated Rate |
$129.37 |
| Max. Negotiated Rate |
$415.82 |
| Rate for Payer: Amida Care Medicaid |
$187.93
|
| Rate for Payer: Cash Price |
$188.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.61
|
| Rate for Payer: Healthfirst Commercial |
$184.81
|
| Rate for Payer: Healthfirst Essential Plan |
$415.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.57
|
| Rate for Payer: Healthfirst QHP |
$184.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.61
|
| Rate for Payer: SOMOS Essential |
$138.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.81
|
|
|
PR NIPPLE/AREOLA RECONSTRUCTION
|
Professional
|
Both
|
$2,947.91
|
|
|
Service Code
|
HCPCS 19350
|
| Min. Negotiated Rate |
$556.53 |
| Max. Negotiated Rate |
$1,788.84 |
| Rate for Payer: Cash Price |
$796.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$795.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$715.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$715.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$755.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$795.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$755.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$795.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$795.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$596.28
|
| Rate for Payer: Healthfirst Commercial |
$795.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,788.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$755.29
|
| Rate for Payer: Healthfirst QHP |
$795.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$556.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$795.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$675.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$556.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$795.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$596.28
|
| Rate for Payer: SOMOS Essential |
$596.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$795.04
|
|
|
PR NIPPLE EXPLORATION
|
Professional
|
Both
|
$1,583.02
|
|
|
Service Code
|
HCPCS 19110
|
| Min. Negotiated Rate |
$297.63 |
| Max. Negotiated Rate |
$956.68 |
| Rate for Payer: Cash Price |
$427.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$425.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$382.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$382.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$403.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$425.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$403.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$425.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$425.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$318.89
|
| Rate for Payer: Healthfirst Commercial |
$425.19
|
| Rate for Payer: Healthfirst Essential Plan |
$956.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$403.93
|
| Rate for Payer: Healthfirst QHP |
$425.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$297.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$425.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$361.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$297.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$425.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$318.89
|
| Rate for Payer: SOMOS Essential |
$318.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$425.19
|
|
|
PR NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Professional
|
Both
|
$81.80
|
|
|
Service Code
|
HCPCS 95012
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$49.43 |
| Rate for Payer: Cash Price |
$22.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.48
|
| Rate for Payer: Healthfirst Commercial |
$21.97
|
| Rate for Payer: Healthfirst Essential Plan |
$49.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.87
|
| Rate for Payer: Healthfirst QHP |
$21.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$21.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$18.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.48
|
| Rate for Payer: SOMOS Essential |
$16.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.97
|
|
|
PR NJX AA&/STRD PLANTAR COMMON DIGITAL NERVES
|
Professional
|
Both
|
$136.22
|
|
|
Service Code
|
HCPCS 64455
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$81.67 |
| Rate for Payer: Cash Price |
$36.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.23
|
| Rate for Payer: Healthfirst Commercial |
$36.30
|
| Rate for Payer: Healthfirst Essential Plan |
$81.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34.48
|
| Rate for Payer: Healthfirst QHP |
$36.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$25.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$36.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$30.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$25.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27.23
|
| Rate for Payer: SOMOS Essential |
$27.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.30
|
|
|
PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC 1 LEVEL
|
Professional
|
Both
|
$539.63
|
|
|
Service Code
|
HCPCS 64479
|
| Min. Negotiated Rate |
$102.89 |
| Max. Negotiated Rate |
$330.73 |
| Rate for Payer: Cash Price |
$147.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.24
|
| Rate for Payer: Healthfirst Commercial |
$146.99
|
| Rate for Payer: Healthfirst Essential Plan |
$330.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.64
|
| Rate for Payer: Healthfirst QHP |
$146.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.24
|
| Rate for Payer: SOMOS Essential |
$110.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.99
|
|
|
PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC EA ADDL
|
Professional
|
Both
|
$253.58
|
|
|
Service Code
|
HCPCS 64480
|
| Min. Negotiated Rate |
$48.26 |
| Max. Negotiated Rate |
$155.12 |
| Rate for Payer: Cash Price |
$68.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$62.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$62.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$65.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$68.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$65.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.70
|
| Rate for Payer: Healthfirst Commercial |
$68.94
|
| Rate for Payer: Healthfirst Essential Plan |
$155.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.49
|
| Rate for Payer: Healthfirst QHP |
$68.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$68.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$58.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$48.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$68.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51.70
|
| Rate for Payer: SOMOS Essential |
$51.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$68.94
|
|
|
PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL
|
Professional
|
Both
|
$458.29
|
|
|
Service Code
|
HCPCS 64483
|
| Min. Negotiated Rate |
$87.25 |
| Max. Negotiated Rate |
$280.44 |
| Rate for Payer: Cash Price |
$126.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.48
|
| Rate for Payer: Healthfirst Commercial |
$124.64
|
| Rate for Payer: Healthfirst Essential Plan |
$280.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.41
|
| Rate for Payer: Healthfirst QHP |
$124.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.48
|
| Rate for Payer: SOMOS Essential |
$93.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.64
|
|
|
PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL
|
Professional
|
Both
|
$212.98
|
|
|
Service Code
|
HCPCS 64484
|
| Min. Negotiated Rate |
$39.26 |
| Max. Negotiated Rate |
$126.18 |
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.06
|
| Rate for Payer: Healthfirst Commercial |
$56.08
|
| Rate for Payer: Healthfirst Essential Plan |
$126.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.28
|
| Rate for Payer: Healthfirst QHP |
$56.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.06
|
| Rate for Payer: SOMOS Essential |
$42.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.08
|
|
|
PR NJX ANES STELLATE GANGLION CRV SYMPATHETIC
|
Professional
|
Both
|
$318.01
|
|
|
Service Code
|
HCPCS 64510
|
| Min. Negotiated Rate |
$60.42 |
| Max. Negotiated Rate |
$194.22 |
| Rate for Payer: Cash Price |
$87.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.74
|
| Rate for Payer: Healthfirst Commercial |
$86.32
|
| Rate for Payer: Healthfirst Essential Plan |
$194.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.00
|
| Rate for Payer: Healthfirst QHP |
$86.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$86.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$73.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.74
|
| Rate for Payer: SOMOS Essential |
$64.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.32
|
|
|
PR NJX ARTERIAL OCCLUSION ARVEN MALFRMJ SPINAL
|
Professional
|
Both
|
$4,592.74
|
|
|
Service Code
|
HCPCS 62294
|
| Min. Negotiated Rate |
$845.08 |
| Max. Negotiated Rate |
$2,716.34 |
| Rate for Payer: Cash Price |
$1,215.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,207.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,086.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,086.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,146.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,207.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,146.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,207.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,207.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$905.45
|
| Rate for Payer: Healthfirst Commercial |
$1,207.26
|
| Rate for Payer: Healthfirst Essential Plan |
$2,716.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,146.90
|
| Rate for Payer: Healthfirst QHP |
$1,207.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$845.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,207.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,026.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$845.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,207.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$905.45
|
| Rate for Payer: SOMOS Essential |
$905.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,207.26
|
|
|
PR NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS
|
Professional
|
Both
|
$286.23
|
|
|
Service Code
|
HCPCS 47531
|
| Min. Negotiated Rate |
$54.63 |
| Max. Negotiated Rate |
$175.61 |
| Rate for Payer: Cash Price |
$78.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$78.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$70.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$74.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$78.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$74.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$78.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$78.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.54
|
| Rate for Payer: Healthfirst Commercial |
$78.05
|
| Rate for Payer: Healthfirst Essential Plan |
$175.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$74.15
|
| Rate for Payer: Healthfirst QHP |
$78.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$54.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$78.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$66.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$54.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$78.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$58.54
|
| Rate for Payer: SOMOS Essential |
$58.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.05
|
|
|
PR NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS
|
Professional
|
Both
|
$861.14
|
|
|
Service Code
|
HCPCS 47532
|
| Min. Negotiated Rate |
$163.63 |
| Max. Negotiated Rate |
$525.96 |
| Rate for Payer: Cash Price |
$233.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$233.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$210.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$222.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$233.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$222.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.32
|
| Rate for Payer: Healthfirst Commercial |
$233.76
|
| Rate for Payer: Healthfirst Essential Plan |
$525.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$222.07
|
| Rate for Payer: Healthfirst QHP |
$233.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$163.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$233.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$198.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$163.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$233.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$175.32
|
| Rate for Payer: SOMOS Essential |
$175.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$233.76
|
|
|
PR NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT
|
Professional
|
Both
|
$314.86
|
|
|
Service Code
|
HCPCS 54235
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$192.22 |
| Rate for Payer: Cash Price |
$85.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$76.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$76.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.07
|
| Rate for Payer: Healthfirst Commercial |
$85.43
|
| Rate for Payer: Healthfirst Essential Plan |
$192.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.16
|
| Rate for Payer: Healthfirst QHP |
$85.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.07
|
| Rate for Payer: SOMOS Essential |
$64.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.43
|
|
