|
PR SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD
|
Professional
|
Both
|
$487.87
|
|
|
Service Code
|
HCPCS 15101
|
| Min. Negotiated Rate |
$90.96 |
| Max. Negotiated Rate |
$292.37 |
| Rate for Payer: Cash Price |
$130.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$116.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$116.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$123.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$123.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.45
|
| Rate for Payer: Healthfirst Commercial |
$129.94
|
| Rate for Payer: Healthfirst Essential Plan |
$292.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$123.44
|
| Rate for Payer: Healthfirst QHP |
$129.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$90.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$129.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$90.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.45
|
| Rate for Payer: SOMOS Essential |
$97.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.94
|
|
|
PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$32.66
|
|
|
Service Code
|
HCPCS 94010 26
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$27.30 |
| Rate for Payer: Amida Care Medicaid |
$27.30
|
| Rate for Payer: Cash Price |
$8.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.60
|
| Rate for Payer: Healthfirst Commercial |
$8.80
|
| Rate for Payer: Healthfirst Essential Plan |
$19.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.36
|
| Rate for Payer: Healthfirst QHP |
$8.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.60
|
| Rate for Payer: SOMOS Essential |
$6.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.80
|
|
|
PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$81.80
|
|
|
Service Code
|
HCPCS 94010 TC
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$51.16 |
| Rate for Payer: Amida Care Medicaid |
$27.30
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.05
|
| Rate for Payer: Healthfirst Commercial |
$22.74
|
| Rate for Payer: Healthfirst Essential Plan |
$51.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.60
|
| Rate for Payer: Healthfirst QHP |
$22.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.05
|
| Rate for Payer: SOMOS Essential |
$17.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.74
|
|
|
PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$114.45
|
|
|
Service Code
|
HCPCS 94010
|
| Min. Negotiated Rate |
$22.09 |
| Max. Negotiated Rate |
$70.99 |
| Rate for Payer: Amida Care Medicaid |
$27.30
|
| Rate for Payer: Cash Price |
$31.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.66
|
| Rate for Payer: Healthfirst Commercial |
$31.55
|
| Rate for Payer: Healthfirst Essential Plan |
$70.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.97
|
| Rate for Payer: Healthfirst QHP |
$31.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$26.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.66
|
| Rate for Payer: SOMOS Essential |
$23.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.55
|
|
|
PR SPONTANEOUS NYSTAGMUS TEST
|
Professional
|
Both
|
$83.02
|
|
|
Service Code
|
HCPCS 92541 26
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$50.74 |
| Rate for Payer: Amida Care Medicaid |
$45.25
|
| Rate for Payer: Cash Price |
$22.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.91
|
| Rate for Payer: Healthfirst Commercial |
$22.55
|
| Rate for Payer: Healthfirst Essential Plan |
$50.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.42
|
| Rate for Payer: Healthfirst QHP |
$22.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.91
|
| Rate for Payer: SOMOS Essential |
$16.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.55
|
|
|
PR SPONTANEOUS NYSTAGMUS TEST
|
Professional
|
Both
|
$103.01
|
|
|
Service Code
|
HCPCS 92541
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$62.62 |
| Rate for Payer: Amida Care Medicaid |
$45.25
|
| Rate for Payer: Cash Price |
$28.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.87
|
| Rate for Payer: Healthfirst Commercial |
$27.83
|
| Rate for Payer: Healthfirst Essential Plan |
$62.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.44
|
| Rate for Payer: Healthfirst QHP |
$27.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$19.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$23.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.87
|
| Rate for Payer: SOMOS Essential |
$20.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.83
|
|
|
PR SPONTANEOUS NYSTAGMUS TEST
|
Professional
|
Both
|
$19.99
|
|
|
Service Code
|
HCPCS 92541 TC
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$45.25 |
| Rate for Payer: Amida Care Medicaid |
$45.25
|
| Rate for Payer: Cash Price |
$5.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.96
|
| Rate for Payer: Healthfirst Commercial |
$5.28
|
| Rate for Payer: Healthfirst Essential Plan |
$11.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.02
|
| Rate for Payer: Healthfirst QHP |
$5.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$4.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$3.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.96
|
| Rate for Payer: SOMOS Essential |
$3.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.28
|
|
|
PR SPUTUM SPECIMEN COLLECTION
|
Professional
|
Both
|
$78.93
|
|
|
Service Code
|
HCPCS 89220
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$50.29 |
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.76
|
| Rate for Payer: Healthfirst Commercial |
$22.35
|
| Rate for Payer: Healthfirst Essential Plan |
$50.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.23
|
| Rate for Payer: Healthfirst QHP |
$22.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$16.76
|
| Rate for Payer: SOMOS Essential |
$16.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.35
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS
|
Professional
|
Both
|
$1,193.12
|
|
|
Service Code
|
HCPCS 37765
|
| Min. Negotiated Rate |
$218.83 |
| Max. Negotiated Rate |
$703.39 |
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$312.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$281.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$281.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$296.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$312.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$296.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$312.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$312.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$234.47
|
| Rate for Payer: Healthfirst Commercial |
$312.62
|
| Rate for Payer: Healthfirst Essential Plan |
$703.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$296.99
|
| Rate for Payer: Healthfirst QHP |
$312.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$218.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$312.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$265.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$218.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$312.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$234.47
|
| Rate for Payer: SOMOS Essential |
$234.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$312.62
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS
|
Professional
|
Both
|
$1,456.63
|
|
|
Service Code
|
HCPCS 37766
|
| Min. Negotiated Rate |
$270.54 |
| Max. Negotiated Rate |
$869.58 |
| Rate for Payer: Cash Price |
$389.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$386.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$347.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$347.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$367.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$386.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$367.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$386.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$386.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.86
|
| Rate for Payer: Healthfirst Commercial |
$386.48
|
| Rate for Payer: Healthfirst Essential Plan |
$869.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$367.16
|
| Rate for Payer: Healthfirst QHP |
$386.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$386.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$328.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$386.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$289.86
|
| Rate for Payer: SOMOS Essential |
$289.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$386.48
|
|
|
PR STAGGERED SPONDAIC WORD
|
Professional
|
Both
|
$203.98
|
|
|
Service Code
|
HCPCS 92572
|
| Min. Negotiated Rate |
$46.63 |
| Max. Negotiated Rate |
$149.87 |
| Rate for Payer: Cash Price |
$63.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.96
|
| Rate for Payer: Healthfirst Commercial |
$66.61
|
| Rate for Payer: Healthfirst Essential Plan |
$149.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.28
|
| Rate for Payer: Healthfirst QHP |
$66.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.96
|
| Rate for Payer: SOMOS Essential |
$49.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.61
|
|
|
PR STANDARDIZED COGNITIVE PERFORMANCE TESTING
|
Professional
|
Both
|
$414.79
|
|
|
Service Code
|
HCPCS 96125
|
| Min. Negotiated Rate |
$79.30 |
| Max. Negotiated Rate |
$254.88 |
| Rate for Payer: Cash Price |
$114.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.96
|
| Rate for Payer: Healthfirst Commercial |
$113.28
|
| Rate for Payer: Healthfirst Essential Plan |
$254.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.62
|
| Rate for Payer: Healthfirst QHP |
$113.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.96
|
| Rate for Payer: SOMOS Essential |
$84.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.28
|
|
|
PR STAPEDECTOMY/STAPEDOTOMY
|
Professional
|
Both
|
$4,021.19
|
|
|
Service Code
|
HCPCS 69660
|
| Min. Negotiated Rate |
$744.58 |
| Max. Negotiated Rate |
$2,393.30 |
| Rate for Payer: Cash Price |
$1,083.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,063.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$957.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$957.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,010.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,063.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,010.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,063.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,063.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$797.77
|
| Rate for Payer: Healthfirst Commercial |
$1,063.69
|
| Rate for Payer: Healthfirst Essential Plan |
$2,393.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,010.51
|
| Rate for Payer: Healthfirst QHP |
$1,063.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$744.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,063.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$904.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$744.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,063.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$797.77
|
| Rate for Payer: SOMOS Essential |
$797.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,063.69
|
|
|
PR STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT
|
Professional
|
Both
|
$5,234.04
|
|
|
Service Code
|
HCPCS 69661
|
| Min. Negotiated Rate |
$969.40 |
| Max. Negotiated Rate |
$3,115.93 |
| Rate for Payer: Cash Price |
$1,410.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,384.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,246.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,246.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,315.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,384.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,315.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,384.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,384.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,038.64
|
| Rate for Payer: Healthfirst Commercial |
$1,384.86
|
| Rate for Payer: Healthfirst Essential Plan |
$3,115.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,315.62
|
| Rate for Payer: Healthfirst QHP |
$1,384.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$969.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,384.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,177.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$969.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,384.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,038.64
|
| Rate for Payer: SOMOS Essential |
$1,038.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,384.86
|
|
|
PR STAPES MOBILIZATION
|
Professional
|
Both
|
$3,489.57
|
|
|
Service Code
|
HCPCS 69650
|
| Min. Negotiated Rate |
$647.18 |
| Max. Negotiated Rate |
$2,080.24 |
| Rate for Payer: Cash Price |
$943.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$924.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$832.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$832.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$878.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$924.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$878.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$924.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$924.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$693.41
|
| Rate for Payer: Healthfirst Commercial |
$924.55
|
| Rate for Payer: Healthfirst Essential Plan |
$2,080.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$878.32
|
| Rate for Payer: Healthfirst QHP |
$924.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$647.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$924.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$785.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$647.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$924.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$693.41
|
| Rate for Payer: SOMOS Essential |
$693.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$924.55
|
|
|
PR STENGER TEST PURE TONE
|
Professional
|
Both
|
$87.54
|
|
|
Service Code
|
HCPCS 92565
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$58.16 |
| Rate for Payer: Amida Care Medicaid |
$7.60
|
| Rate for Payer: Cash Price |
$24.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.39
|
| Rate for Payer: Healthfirst Commercial |
$25.85
|
| Rate for Payer: Healthfirst Essential Plan |
$58.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.56
|
| Rate for Payer: Healthfirst QHP |
$25.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$25.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$21.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.39
|
| Rate for Payer: SOMOS Essential |
$19.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.85
|
|
|
PR STENGER TEST SPEECH
|
Professional
|
Both
|
$88.97
|
|
|
Service Code
|
HCPCS 92577
|
| Min. Negotiated Rate |
$18.91 |
| Max. Negotiated Rate |
$60.77 |
| Rate for Payer: Cash Price |
$26.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$24.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$25.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.26
|
| Rate for Payer: Healthfirst Commercial |
$27.01
|
| Rate for Payer: Healthfirst Essential Plan |
$60.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.66
|
| Rate for Payer: Healthfirst QHP |
$27.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$27.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$22.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$18.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.26
|
| Rate for Payer: SOMOS Essential |
$20.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.01
|
|
|
PR STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR
|
Professional
|
Both
|
$872.31
|
|
|
Service Code
|
HCPCS 36908
|
| Min. Negotiated Rate |
$163.37 |
| Max. Negotiated Rate |
$525.11 |
| Rate for Payer: Cash Price |
$234.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$233.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$210.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$221.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$233.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$221.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.03
|
| Rate for Payer: Healthfirst Commercial |
$233.38
|
| Rate for Payer: Healthfirst Essential Plan |
$525.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$221.71
|
| Rate for Payer: Healthfirst QHP |
$233.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$163.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$233.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$198.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$163.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$233.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$175.03
|
| Rate for Payer: SOMOS Essential |
$175.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$233.38
|
|
|
PR STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$83.06
|
|
|
Service Code
|
HCPCS G6002 26
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$51.34 |
| Rate for Payer: Cash Price |
$22.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.11
|
| Rate for Payer: Healthfirst Commercial |
$22.82
|
| Rate for Payer: Healthfirst Essential Plan |
$51.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.68
|
| Rate for Payer: Healthfirst QHP |
$22.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$15.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$22.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$15.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.11
|
| Rate for Payer: SOMOS Essential |
$17.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.82
|
|
|
PR STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$234.19
|
|
|
Service Code
|
HCPCS G6002 TC
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$144.63 |
| Rate for Payer: Cash Price |
$65.07
|
| 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 STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$317.24
|
|
|
Service Code
|
HCPCS G6002
|
| Min. Negotiated Rate |
$60.97 |
| Max. Negotiated Rate |
$195.97 |
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$87.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$78.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$82.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$87.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$82.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$87.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.33
|
| Rate for Payer: Healthfirst Commercial |
$87.10
|
| Rate for Payer: Healthfirst Essential Plan |
$195.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$82.75
|
| Rate for Payer: Healthfirst QHP |
$87.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$60.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$87.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$74.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$60.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$87.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$65.33
|
| Rate for Payer: SOMOS Essential |
$65.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$87.10
|
|
|
PR STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES
|
Professional
|
Both
|
$6,784.86
|
|
|
Service Code
|
HCPCS 61750
|
| Min. Negotiated Rate |
$1,245.15 |
| Max. Negotiated Rate |
$4,002.26 |
| Rate for Payer: Cash Price |
$1,791.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,778.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,600.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,600.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,689.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,778.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,689.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,778.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,778.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,334.09
|
| Rate for Payer: Healthfirst Commercial |
$1,778.78
|
| Rate for Payer: Healthfirst Essential Plan |
$4,002.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,689.84
|
| Rate for Payer: Healthfirst QHP |
$1,778.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,245.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,778.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,511.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,245.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,778.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,334.09
|
| Rate for Payer: SOMOS Essential |
$1,334.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,778.78
|
|
|
PR STEREOTACTIC COMPUTER ASSISTED PX SPINAL
|
Professional
|
Both
|
$1,095.36
|
|
|
Service Code
|
HCPCS 61783
|
| Min. Negotiated Rate |
$199.49 |
| Max. Negotiated Rate |
$641.23 |
| Rate for Payer: Cash Price |
$287.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$284.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$256.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$256.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$270.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$284.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$270.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$284.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.74
|
| Rate for Payer: Healthfirst Commercial |
$284.99
|
| Rate for Payer: Healthfirst Essential Plan |
$641.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$270.74
|
| Rate for Payer: Healthfirst QHP |
$284.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$284.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$242.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$284.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.74
|
| Rate for Payer: SOMOS Essential |
$213.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$284.99
|
|
|
PR STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES
|
Professional
|
Both
|
$6,639.82
|
|
|
Service Code
|
HCPCS 61798
|
| Min. Negotiated Rate |
$1,216.21 |
| Max. Negotiated Rate |
$3,909.26 |
| Rate for Payer: Cash Price |
$1,754.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,737.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,563.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,563.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,650.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,737.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,650.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,737.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,737.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,303.09
|
| Rate for Payer: Healthfirst Commercial |
$1,737.45
|
| Rate for Payer: Healthfirst Essential Plan |
$3,909.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,650.58
|
| Rate for Payer: Healthfirst QHP |
$1,737.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,216.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,737.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,476.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,216.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,737.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,303.09
|
| Rate for Payer: SOMOS Essential |
$1,303.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,737.45
|
|
|
PR STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES
|
Professional
|
Both
|
$4,901.33
|
|
|
Service Code
|
HCPCS 61796
|
| Min. Negotiated Rate |
$901.10 |
| Max. Negotiated Rate |
$2,896.40 |
| Rate for Payer: Cash Price |
$1,296.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,287.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,158.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,158.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,222.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,287.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,222.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,287.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,287.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$965.47
|
| Rate for Payer: Healthfirst Commercial |
$1,287.29
|
| Rate for Payer: Healthfirst Essential Plan |
$2,896.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,222.93
|
| Rate for Payer: Healthfirst QHP |
$1,287.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$901.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,287.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,094.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$901.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,287.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$965.47
|
| Rate for Payer: SOMOS Essential |
$965.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,287.29
|
|
