|
PR STRTCTC BX ASPIR/EXC BURR ICRA LESION W/CT&I/MR
|
Professional
|
Both
|
$6,674.26
|
|
|
Service Code
|
HCPCS 61751
|
| Min. Negotiated Rate |
$1,225.37 |
| Max. Negotiated Rate |
$3,938.69 |
| Rate for Payer: Cash Price |
$1,765.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,750.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,575.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,575.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,663.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,750.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,663.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,750.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,750.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,312.90
|
| Rate for Payer: Healthfirst Commercial |
$1,750.53
|
| Rate for Payer: Healthfirst Essential Plan |
$3,938.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,663.00
|
| Rate for Payer: Healthfirst QHP |
$1,750.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,225.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,750.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,487.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,225.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,750.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,312.90
|
| Rate for Payer: SOMOS Essential |
$1,312.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,750.53
|
|
|
PR STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL
|
Professional
|
Both
|
$1,141.60
|
|
|
Service Code
|
HCPCS 61781
|
| Min. Negotiated Rate |
$206.35 |
| Max. Negotiated Rate |
$663.28 |
| Rate for Payer: Cash Price |
$297.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$294.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$265.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$265.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$280.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$294.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$280.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$294.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$294.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$221.09
|
| Rate for Payer: Healthfirst Commercial |
$294.79
|
| Rate for Payer: Healthfirst Essential Plan |
$663.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$280.05
|
| Rate for Payer: Healthfirst QHP |
$294.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$206.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$294.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$250.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$206.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$294.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$221.09
|
| Rate for Payer: SOMOS Essential |
$221.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$294.79
|
|
|
PR STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL
|
Professional
|
Both
|
$739.76
|
|
|
Service Code
|
HCPCS 61782
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$445.63 |
| Rate for Payer: Cash Price |
$198.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$198.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$178.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$178.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$188.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$198.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$188.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.54
|
| Rate for Payer: Healthfirst Commercial |
$198.06
|
| Rate for Payer: Healthfirst Essential Plan |
$445.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$188.16
|
| Rate for Payer: Healthfirst QHP |
$198.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$138.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$198.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$168.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$138.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$198.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$148.54
|
| Rate for Payer: SOMOS Essential |
$148.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$198.06
|
|
|
PR STRTCTC IMPLTJ ELTRD CEREBRUM SEIZURE MONITORING
|
Professional
|
Both
|
$7,660.77
|
|
|
Service Code
|
HCPCS 61760
|
| Min. Negotiated Rate |
$1,401.05 |
| Max. Negotiated Rate |
$4,503.38 |
| Rate for Payer: Cash Price |
$2,005.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,001.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,801.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,801.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,901.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,001.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,901.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,001.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,001.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,501.12
|
| Rate for Payer: Healthfirst Commercial |
$2,001.50
|
| Rate for Payer: Healthfirst Essential Plan |
$4,503.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,901.42
|
| Rate for Payer: Healthfirst QHP |
$2,001.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,401.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,001.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,701.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,401.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,001.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,501.12
|
| Rate for Payer: SOMOS Essential |
$1,501.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,001.50
|
|
|
PR STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY
|
Professional
|
Both
|
$7,247.45
|
|
|
Service Code
|
HCPCS 61863
|
| Min. Negotiated Rate |
$1,329.81 |
| Max. Negotiated Rate |
$4,274.39 |
| Rate for Payer: Cash Price |
$1,917.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,899.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,709.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,709.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,804.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,899.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,804.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,899.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,899.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,424.80
|
| Rate for Payer: Healthfirst Commercial |
$1,899.73
|
| Rate for Payer: Healthfirst Essential Plan |
$4,274.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,804.74
|
| Rate for Payer: Healthfirst QHP |
$1,899.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,329.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,899.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,614.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,329.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,899.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,424.80
|
| Rate for Payer: SOMOS Essential |
$1,424.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,899.73
|
|
|
PR STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY
|
Professional
|
Both
|
$1,365.39
|
|
|
Service Code
|
HCPCS 61864
|
| Min. Negotiated Rate |
$247.67 |
| Max. Negotiated Rate |
$796.07 |
| Rate for Payer: Cash Price |
$356.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$353.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$318.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$318.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$336.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$353.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$336.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$353.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$353.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$265.36
|
| Rate for Payer: Healthfirst Commercial |
$353.81
|
| Rate for Payer: Healthfirst Essential Plan |
$796.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$336.12
|
| Rate for Payer: Healthfirst QHP |
$353.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$247.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$353.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$300.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$247.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$353.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$265.36
|
| Rate for Payer: SOMOS Essential |
$265.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$353.81
|
|
|
PR STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY
|
Professional
|
Both
|
$11,017.97
|
|
|
Service Code
|
HCPCS 61867
|
| Min. Negotiated Rate |
$2,010.67 |
| Max. Negotiated Rate |
$6,462.85 |
| Rate for Payer: Cash Price |
$2,900.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,872.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,585.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,585.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,728.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,872.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,728.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,872.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,872.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,154.28
|
| Rate for Payer: Healthfirst Commercial |
$2,872.38
|
| Rate for Payer: Healthfirst Essential Plan |
$6,462.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,728.76
|
| Rate for Payer: Healthfirst QHP |
$2,872.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,010.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,872.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,441.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,010.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,872.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,154.28
|
| Rate for Payer: SOMOS Essential |
$2,154.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,872.38
|
|
|
PR STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY
|
Professional
|
Both
|
$2,411.26
|
|
|
Service Code
|
HCPCS 61868
|
| Min. Negotiated Rate |
$436.36 |
| Max. Negotiated Rate |
$1,402.58 |
| Rate for Payer: Cash Price |
$631.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$623.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$561.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$561.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$592.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$623.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$592.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$623.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$623.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$467.53
|
| Rate for Payer: Healthfirst Commercial |
$623.37
|
| Rate for Payer: Healthfirst Essential Plan |
$1,402.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$592.20
|
| Rate for Payer: Healthfirst QHP |
$623.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$436.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$623.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$529.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$436.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$623.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$467.53
|
| Rate for Payer: SOMOS Essential |
$467.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$623.37
|
|
|
PR STRTCTC LOCLZJ INSJ CATH/PRB PLMT RADJ SRC
|
Professional
|
Both
|
$7,834.30
|
|
|
Service Code
|
HCPCS 61770
|
| Min. Negotiated Rate |
$1,432.56 |
| Max. Negotiated Rate |
$4,604.65 |
| Rate for Payer: Cash Price |
$2,065.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,046.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,841.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,841.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,944.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,046.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,944.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,046.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,046.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,534.88
|
| Rate for Payer: Healthfirst Commercial |
$2,046.51
|
| Rate for Payer: Healthfirst Essential Plan |
$4,604.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,944.18
|
| Rate for Payer: Healthfirst QHP |
$2,046.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,432.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,046.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,739.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,432.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,046.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,534.88
|
| Rate for Payer: SOMOS Essential |
$1,534.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,046.51
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX
|
Professional
|
Both
|
$1,462.58
|
|
|
Service Code
|
HCPCS 61799
|
| Min. Negotiated Rate |
$264.65 |
| Max. Negotiated Rate |
$850.66 |
| Rate for Payer: Cash Price |
$383.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$378.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$340.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$340.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$359.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$378.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$359.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$378.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$378.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$283.55
|
| Rate for Payer: Healthfirst Commercial |
$378.07
|
| Rate for Payer: Healthfirst Essential Plan |
$850.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$359.17
|
| Rate for Payer: Healthfirst QHP |
$378.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$264.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$378.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$321.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$264.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$378.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$283.55
|
| Rate for Payer: SOMOS Essential |
$283.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$378.07
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE
|
Professional
|
Both
|
$1,056.27
|
|
|
Service Code
|
HCPCS 61797
|
| Min. Negotiated Rate |
$191.98 |
| Max. Negotiated Rate |
$617.09 |
| Rate for Payer: Cash Price |
$277.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$274.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$246.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$246.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$274.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$274.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$274.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.69
|
| Rate for Payer: Healthfirst Commercial |
$274.26
|
| Rate for Payer: Healthfirst Essential Plan |
$617.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$260.55
|
| Rate for Payer: Healthfirst QHP |
$274.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$274.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$233.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$274.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$205.69
|
| Rate for Payer: SOMOS Essential |
$205.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$274.26
|
|
|
PR STRTCTC STIMJ SPI CORD PRQ SPX N/FLWD OTH SURG
|
Professional
|
Both
|
$2,796.92
|
|
|
Service Code
|
HCPCS 63610
|
| Min. Negotiated Rate |
$509.89 |
| Max. Negotiated Rate |
$1,638.94 |
| Rate for Payer: Cash Price |
$734.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$728.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$655.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$655.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$692.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$728.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$692.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$728.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$728.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$546.32
|
| Rate for Payer: Healthfirst Commercial |
$728.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,638.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$692.00
|
| Rate for Payer: Healthfirst QHP |
$728.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$509.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$728.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$619.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$509.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$728.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$546.32
|
| Rate for Payer: SOMOS Essential |
$546.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$728.42
|
|
|
PR STUMP ELONGATION UPPER EXTREMITY
|
Professional
|
Both
|
$5,409.74
|
|
|
Service Code
|
HCPCS 24935
|
| Min. Negotiated Rate |
$1,011.31 |
| Max. Negotiated Rate |
$3,250.64 |
| Rate for Payer: Cash Price |
$1,457.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,444.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,300.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,300.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,372.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,444.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,372.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,444.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,444.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,083.55
|
| Rate for Payer: Healthfirst Commercial |
$1,444.73
|
| Rate for Payer: Healthfirst Essential Plan |
$3,250.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,372.49
|
| Rate for Payer: Healthfirst QHP |
$1,444.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,011.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,444.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,228.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,011.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,444.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,083.55
|
| Rate for Payer: SOMOS Essential |
$1,083.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,444.73
|
|
|
PR SUBCONJUNCTIVAL INJECTION
|
Professional
|
Both
|
$139.90
|
|
|
Service Code
|
HCPCS 68200
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: Cash Price |
$38.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.78
|
| Rate for Payer: Healthfirst Commercial |
$38.37
|
| Rate for Payer: Healthfirst Essential Plan |
$86.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.45
|
| Rate for Payer: Healthfirst QHP |
$38.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$26.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$26.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28.78
|
| Rate for Payer: SOMOS Essential |
$28.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.37
|
|
|
PR SUBCUTANEOUS HORMONE PELLET IMPLANTATION
|
Professional
|
Both
|
$240.35
|
|
|
Service Code
|
HCPCS 11980
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$141.05 |
| Rate for Payer: Cash Price |
$63.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.02
|
| Rate for Payer: Healthfirst Commercial |
$62.69
|
| Rate for Payer: Healthfirst Essential Plan |
$141.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.56
|
| Rate for Payer: Healthfirst QHP |
$62.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$43.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$43.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.02
|
| Rate for Payer: SOMOS Essential |
$47.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.69
|
|
|
PR SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR
|
Professional
|
Both
|
$64.09
|
|
|
Service Code
|
HCPCS 96370
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$41.53 |
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.85
|
| Rate for Payer: Healthfirst Commercial |
$18.46
|
| Rate for Payer: Healthfirst Essential Plan |
$41.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.54
|
| Rate for Payer: Healthfirst QHP |
$18.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$18.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$15.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.85
|
| Rate for Payer: SOMOS Essential |
$13.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.46
|
|
|
PR SUBCUTANEOUS INFUSION INITIAL 1 HR W/PUMP SET-UP
|
Professional
|
Both
|
$602.18
|
|
|
Service Code
|
HCPCS 96369
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$361.94 |
| Rate for Payer: Cash Price |
$166.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$160.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$152.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$152.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.64
|
| Rate for Payer: Healthfirst Commercial |
$160.86
|
| Rate for Payer: Healthfirst Essential Plan |
$361.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$152.82
|
| Rate for Payer: Healthfirst QHP |
$160.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$160.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$160.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.64
|
| Rate for Payer: SOMOS Essential |
$120.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.86
|
|
|
PR SUBCUTANEOUS INJECTION FILLING MATERIAL 1 CC/<
|
Professional
|
Both
|
$230.79
|
|
|
Service Code
|
HCPCS 11950
|
| Min. Negotiated Rate |
$42.66 |
| Max. Negotiated Rate |
$137.14 |
| Rate for Payer: Cash Price |
$60.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$54.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$60.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.71
|
| Rate for Payer: Healthfirst Commercial |
$60.95
|
| Rate for Payer: Healthfirst Essential Plan |
$137.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$57.90
|
| Rate for Payer: Healthfirst QHP |
$60.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$42.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$60.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$51.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$42.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$60.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$45.71
|
| Rate for Payer: SOMOS Essential |
$45.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.95
|
|
|
PR SUBCUTANEOUS INJECTION FILLING MATRL >10.0 CC
|
Professional
|
Both
|
$488.60
|
|
|
Service Code
|
HCPCS 11954
|
| Min. Negotiated Rate |
$91.39 |
| Max. Negotiated Rate |
$293.74 |
| Rate for Payer: Cash Price |
$130.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$130.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$117.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$130.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.91
|
| Rate for Payer: Healthfirst Commercial |
$130.55
|
| Rate for Payer: Healthfirst Essential Plan |
$293.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.02
|
| Rate for Payer: Healthfirst QHP |
$130.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$130.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$110.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$130.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.91
|
| Rate for Payer: SOMOS Essential |
$97.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.55
|
|
|
PR SUBCUTANEOUS INJECTION FILLING MATRL 1.1-5.0 CC
|
Professional
|
Both
|
$318.50
|
|
|
Service Code
|
HCPCS 11951
|
| Min. Negotiated Rate |
$58.98 |
| Max. Negotiated Rate |
$189.56 |
| Rate for Payer: Cash Price |
$85.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$84.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$75.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$80.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$84.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$80.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$63.19
|
| Rate for Payer: Healthfirst Commercial |
$84.25
|
| Rate for Payer: Healthfirst Essential Plan |
$189.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$80.04
|
| Rate for Payer: Healthfirst QHP |
$84.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$84.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$71.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$84.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$63.19
|
| Rate for Payer: SOMOS Essential |
$63.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$84.25
|
|
|
PR SUBCUTANEOUS INJECTION FILLING MATRL 5.1-10.0CC
|
Professional
|
Both
|
$444.68
|
|
|
Service Code
|
HCPCS 11952
|
| Min. Negotiated Rate |
$82.65 |
| Max. Negotiated Rate |
$265.66 |
| Rate for Payer: Cash Price |
$119.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.55
|
| Rate for Payer: Healthfirst Commercial |
$118.07
|
| Rate for Payer: Healthfirst Essential Plan |
$265.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.17
|
| Rate for Payer: Healthfirst QHP |
$118.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.55
|
| Rate for Payer: SOMOS Essential |
$88.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.07
|
|
|
PR SUBDURAL IMPLTJ ELECTRODES SEIZURE MONITORING
|
Professional
|
Both
|
$5,899.04
|
|
|
Service Code
|
HCPCS 61531
|
| Min. Negotiated Rate |
$1,085.73 |
| Max. Negotiated Rate |
$3,489.86 |
| Rate for Payer: Cash Price |
$1,561.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,551.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,395.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,395.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,473.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,551.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,473.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,551.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,551.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,163.29
|
| Rate for Payer: Healthfirst Commercial |
$1,551.05
|
| Rate for Payer: Healthfirst Essential Plan |
$3,489.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,473.50
|
| Rate for Payer: Healthfirst QHP |
$1,551.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,085.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,551.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,318.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,085.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,551.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,163.29
|
| Rate for Payer: SOMOS Essential |
$1,163.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,551.05
|
|
|
PR SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT
|
Professional
|
Both
|
$545.37
|
|
|
Service Code
|
HCPCS 61000
|
| Min. Negotiated Rate |
$99.76 |
| Max. Negotiated Rate |
$320.65 |
| Rate for Payer: Cash Price |
$143.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.88
|
| Rate for Payer: Healthfirst Commercial |
$142.51
|
| Rate for Payer: Healthfirst Essential Plan |
$320.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.38
|
| Rate for Payer: Healthfirst QHP |
$142.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.88
|
| Rate for Payer: SOMOS Essential |
$106.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.51
|
|
|
PR SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI SBSQ
|
Professional
|
Both
|
$511.95
|
|
|
Service Code
|
HCPCS 61001
|
| Min. Negotiated Rate |
$94.93 |
| Max. Negotiated Rate |
$305.12 |
| Rate for Payer: Cash Price |
$136.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$135.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$122.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$122.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Healthfirst Commercial |
$135.61
|
| Rate for Payer: Healthfirst Essential Plan |
$305.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.83
|
| Rate for Payer: Healthfirst QHP |
$135.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$135.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$135.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.71
|
| Rate for Payer: SOMOS Essential |
$101.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.61
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM 1ST 100SQ CM
|
Professional
|
Both
|
$975.45
|
|
|
Service Code
|
HCPCS 15277
|
| Min. Negotiated Rate |
$180.43 |
| Max. Negotiated Rate |
$579.96 |
| Rate for Payer: Cash Price |
$258.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$244.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$244.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$193.32
|
| Rate for Payer: Healthfirst Commercial |
$257.76
|
| Rate for Payer: Healthfirst Essential Plan |
$579.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$244.87
|
| Rate for Payer: Healthfirst QHP |
$257.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$180.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$257.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$219.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$180.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$193.32
|
| Rate for Payer: SOMOS Essential |
$193.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.76
|
|
