|
PR SYMPATHECTOMY LUMBAR
|
Professional
|
Both
|
$3,445.58
|
|
|
Service Code
|
HCPCS 64818
|
| Min. Negotiated Rate |
$647.02 |
| Max. Negotiated Rate |
$2,079.72 |
| Rate for Payer: Cash Price |
$928.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$924.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$831.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$831.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$878.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$924.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$878.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$924.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$924.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$693.24
|
| Rate for Payer: Healthfirst Commercial |
$924.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,079.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$878.10
|
| Rate for Payer: Healthfirst QHP |
$924.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$647.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$924.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$785.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$647.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$924.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$693.24
|
| Rate for Payer: SOMOS Essential |
$693.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$924.32
|
|
|
PR SYMPATHECTOMY RADIAL ARTERY
|
Professional
|
Both
|
$3,049.80
|
|
|
Service Code
|
HCPCS 64821
|
| Min. Negotiated Rate |
$584.78 |
| Max. Negotiated Rate |
$1,879.65 |
| Rate for Payer: Cash Price |
$838.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$835.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$751.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$751.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$793.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$835.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$793.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$835.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$835.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$626.55
|
| Rate for Payer: Healthfirst Commercial |
$835.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,879.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$793.63
|
| Rate for Payer: Healthfirst QHP |
$835.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$584.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$835.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$710.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$584.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$835.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$626.55
|
| Rate for Payer: SOMOS Essential |
$626.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$835.40
|
|
|
PR SYMPATHECTOMY SUPERFICIAL PALMAR ARCH
|
Professional
|
Both
|
$3,505.99
|
|
|
Service Code
|
HCPCS 64823
|
| Min. Negotiated Rate |
$661.25 |
| Max. Negotiated Rate |
$2,125.44 |
| Rate for Payer: Cash Price |
$947.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$944.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$850.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$850.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$897.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$944.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$897.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$944.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$944.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$708.48
|
| Rate for Payer: Healthfirst Commercial |
$944.64
|
| Rate for Payer: Healthfirst Essential Plan |
$2,125.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$897.41
|
| Rate for Payer: Healthfirst QHP |
$944.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$661.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$944.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$802.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$661.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$944.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$708.48
|
| Rate for Payer: SOMOS Essential |
$708.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$944.64
|
|
|
PR SYMPATHECTOMY THORACOLUMBAR
|
Professional
|
Both
|
$5,251.23
|
|
|
Service Code
|
HCPCS 64809
|
| Min. Negotiated Rate |
$963.75 |
| Max. Negotiated Rate |
$3,097.78 |
| Rate for Payer: Cash Price |
$1,388.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,376.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,239.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,239.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,307.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,376.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,307.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,376.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,376.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,032.59
|
| Rate for Payer: Healthfirst Commercial |
$1,376.79
|
| Rate for Payer: Healthfirst Essential Plan |
$3,097.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,307.95
|
| Rate for Payer: Healthfirst QHP |
$1,376.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$963.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,376.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,170.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$963.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,376.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,032.59
|
| Rate for Payer: SOMOS Essential |
$1,032.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,376.79
|
|
|
PR SYMPATHECTOMY ULNAR ARTERY
|
Professional
|
Both
|
$3,097.47
|
|
|
Service Code
|
HCPCS 64822
|
| Min. Negotiated Rate |
$584.78 |
| Max. Negotiated Rate |
$1,879.65 |
| Rate for Payer: Cash Price |
$838.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$835.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$751.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$751.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$793.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$835.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$793.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$835.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$835.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$626.55
|
| Rate for Payer: Healthfirst Commercial |
$835.40
|
| Rate for Payer: Healthfirst Essential Plan |
$1,879.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$793.63
|
| Rate for Payer: Healthfirst QHP |
$835.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$584.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$835.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$710.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$584.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$835.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$626.55
|
| Rate for Payer: SOMOS Essential |
$626.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$835.40
|
|
|
PR SYMPHYSIOTOMY HORSESHOE KDN W/WO PLOP UNI/BI
|
Professional
|
Both
|
$4,780.09
|
|
|
Service Code
|
HCPCS 50540
|
| Min. Negotiated Rate |
$908.80 |
| Max. Negotiated Rate |
$2,921.13 |
| Rate for Payer: Cash Price |
$1,306.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,298.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,168.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,168.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,233.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,298.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,233.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,298.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,298.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$973.71
|
| Rate for Payer: Healthfirst Commercial |
$1,298.28
|
| Rate for Payer: Healthfirst Essential Plan |
$2,921.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,233.37
|
| Rate for Payer: Healthfirst QHP |
$1,298.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$908.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,298.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,103.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$908.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,298.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$973.71
|
| Rate for Payer: SOMOS Essential |
$973.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,298.28
|
|
|
PR SYNDACTYLIZATION TOES
|
Professional
|
Both
|
$1,463.49
|
|
|
Service Code
|
HCPCS 28280
|
| Min. Negotiated Rate |
$274.39 |
| Max. Negotiated Rate |
$881.96 |
| Rate for Payer: Cash Price |
$399.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$391.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$352.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$352.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$372.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$391.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$372.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$391.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$391.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$293.99
|
| Rate for Payer: Healthfirst Commercial |
$391.98
|
| Rate for Payer: Healthfirst Essential Plan |
$881.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$372.38
|
| Rate for Payer: Healthfirst QHP |
$391.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$274.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$391.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$333.18
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$274.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$391.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.99
|
| Rate for Payer: SOMOS Essential |
$293.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$391.98
|
|
|
PR SYNOVECTOMY CARPOMETACARPAL JOINT
|
Professional
|
Both
|
$2,093.21
|
|
|
Service Code
|
HCPCS 26130
|
| Min. Negotiated Rate |
$397.04 |
| Max. Negotiated Rate |
$1,276.20 |
| Rate for Payer: Cash Price |
$569.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$567.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$510.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$510.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$538.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$567.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$538.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$567.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$567.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$425.40
|
| Rate for Payer: Healthfirst Commercial |
$567.20
|
| Rate for Payer: Healthfirst Essential Plan |
$1,276.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$538.84
|
| Rate for Payer: Healthfirst QHP |
$567.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$397.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$567.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$482.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$397.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$567.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$425.40
|
| Rate for Payer: SOMOS Essential |
$425.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$567.20
|
|
|
PR SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT
|
Professional
|
Both
|
$1,696.31
|
|
|
Service Code
|
HCPCS 25118
|
| Min. Negotiated Rate |
$323.73 |
| Max. Negotiated Rate |
$1,040.56 |
| Rate for Payer: Cash Price |
$463.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$462.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$416.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$416.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$439.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$462.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$439.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$462.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$462.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$346.85
|
| Rate for Payer: Healthfirst Commercial |
$462.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,040.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$439.35
|
| Rate for Payer: Healthfirst QHP |
$462.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$323.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$462.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$393.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$323.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$462.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$346.85
|
| Rate for Payer: SOMOS Essential |
$346.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$462.47
|
|
|
PR SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH
|
Professional
|
Both
|
$1,377.18
|
|
|
Service Code
|
HCPCS 28072
|
| Min. Negotiated Rate |
$265.05 |
| Max. Negotiated Rate |
$851.94 |
| Rate for Payer: Cash Price |
$379.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$378.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$340.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$340.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$359.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$378.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$359.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$378.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$378.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$283.98
|
| Rate for Payer: Healthfirst Commercial |
$378.64
|
| Rate for Payer: Healthfirst Essential Plan |
$851.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$359.71
|
| Rate for Payer: Healthfirst QHP |
$378.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$265.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$378.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$321.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$265.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$378.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$283.98
|
| Rate for Payer: SOMOS Essential |
$283.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$378.64
|
|
|
PR SYNOVECTOMY TENDON SHEATH FOOT EXTENSOR
|
Professional
|
Both
|
$1,238.16
|
|
|
Service Code
|
HCPCS 28088
|
| Min. Negotiated Rate |
$241.24 |
| Max. Negotiated Rate |
$775.42 |
| Rate for Payer: Cash Price |
$344.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$344.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$310.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$310.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$327.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$344.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$327.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$344.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$344.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$258.47
|
| Rate for Payer: Healthfirst Commercial |
$344.63
|
| Rate for Payer: Healthfirst Essential Plan |
$775.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$327.40
|
| Rate for Payer: Healthfirst QHP |
$344.63
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$241.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$344.63
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$292.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$241.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$344.63
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$258.47
|
| Rate for Payer: SOMOS Essential |
$258.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$344.63
|
|
|
PR SYNOVECTOMY TENDON SHEATH FOOT FLEXOR
|
Professional
|
Both
|
$1,515.71
|
|
|
Service Code
|
HCPCS 28086
|
| Min. Negotiated Rate |
$283.66 |
| Max. Negotiated Rate |
$911.77 |
| Rate for Payer: Cash Price |
$410.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$405.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$364.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$364.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$384.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$405.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$384.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$405.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$405.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$303.92
|
| Rate for Payer: Healthfirst Commercial |
$405.23
|
| Rate for Payer: Healthfirst Essential Plan |
$911.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$384.97
|
| Rate for Payer: Healthfirst QHP |
$405.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$283.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$405.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$344.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$283.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$405.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$303.92
|
| Rate for Payer: SOMOS Essential |
$303.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$405.23
|
|
|
PR SYNTHETIC SENTENCE IDENTIFICATION TEST
|
Professional
|
Both
|
$172.38
|
|
|
Service Code
|
HCPCS 92576
|
| Min. Negotiated Rate |
$37.11 |
| Max. Negotiated Rate |
$119.30 |
| Rate for Payer: Cash Price |
$50.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$47.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$39.77
|
| Rate for Payer: Healthfirst Commercial |
$53.02
|
| Rate for Payer: Healthfirst Essential Plan |
$119.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$50.37
|
| Rate for Payer: Healthfirst QHP |
$53.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$39.77
|
| Rate for Payer: SOMOS Essential |
$39.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.02
|
|
|
PR SYNVCT INTERTARSAL/TARSOMETATARSAL JT EA SPX
|
Professional
|
Both
|
$1,446.48
|
|
|
Service Code
|
HCPCS 28070
|
| Min. Negotiated Rate |
$280.52 |
| Max. Negotiated Rate |
$901.66 |
| Rate for Payer: Cash Price |
$397.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$400.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$360.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$360.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$380.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$400.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$380.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$300.56
|
| Rate for Payer: Healthfirst Commercial |
$400.74
|
| Rate for Payer: Healthfirst Essential Plan |
$901.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$380.70
|
| Rate for Payer: Healthfirst QHP |
$400.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$280.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$400.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$340.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$280.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$400.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$300.56
|
| Rate for Payer: SOMOS Essential |
$300.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$400.74
|
|
|
PR SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD
|
Professional
|
Both
|
$2,454.52
|
|
|
Service Code
|
HCPCS 26135
|
| Min. Negotiated Rate |
$465.92 |
| Max. Negotiated Rate |
$1,497.60 |
| Rate for Payer: Cash Price |
$665.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$665.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$599.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$599.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$632.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$665.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$632.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$665.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$665.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$499.20
|
| Rate for Payer: Healthfirst Commercial |
$665.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,497.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$632.32
|
| Rate for Payer: Healthfirst QHP |
$665.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$465.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$665.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$565.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$465.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$665.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$499.20
|
| Rate for Payer: SOMOS Essential |
$499.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$665.60
|
|
|
PR SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT
|
Professional
|
Both
|
$2,245.78
|
|
|
Service Code
|
HCPCS 26140
|
| Min. Negotiated Rate |
$426.70 |
| Max. Negotiated Rate |
$1,371.53 |
| Rate for Payer: Cash Price |
$612.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$609.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$548.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$548.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$579.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$609.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$579.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$609.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$609.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$457.18
|
| Rate for Payer: Healthfirst Commercial |
$609.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,371.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$579.09
|
| Rate for Payer: Healthfirst QHP |
$609.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$426.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$609.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$518.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$426.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$609.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$457.18
|
| Rate for Payer: SOMOS Essential |
$457.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$609.57
|
|
|
PR SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN
|
Professional
|
Both
|
$2,285.43
|
|
|
Service Code
|
HCPCS 26145
|
| Min. Negotiated Rate |
$434.70 |
| Max. Negotiated Rate |
$1,397.25 |
| Rate for Payer: Cash Price |
$621.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$621.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$558.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$558.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$589.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$621.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$589.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$621.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$621.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$465.75
|
| Rate for Payer: Healthfirst Commercial |
$621.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,397.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$589.95
|
| Rate for Payer: Healthfirst QHP |
$621.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$434.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$621.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$527.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$434.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$621.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$465.75
|
| Rate for Payer: SOMOS Essential |
$465.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$621.00
|
|
|
PR SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA
|
Professional
|
Both
|
$2,239.62
|
|
|
Service Code
|
HCPCS 25119
|
| Min. Negotiated Rate |
$424.24 |
| Max. Negotiated Rate |
$1,363.63 |
| Rate for Payer: Cash Price |
$607.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$606.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$545.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$545.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$575.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$606.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$575.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$606.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$606.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$454.55
|
| Rate for Payer: Healthfirst Commercial |
$606.06
|
| Rate for Payer: Healthfirst Essential Plan |
$1,363.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$575.76
|
| Rate for Payer: Healthfirst QHP |
$606.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$424.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$606.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$515.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$424.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$606.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$454.55
|
| Rate for Payer: SOMOS Essential |
$454.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$606.06
|
|
|
PR TALECTOMY ASTRAGALECTOMY
|
Professional
|
Both
|
$2,575.72
|
|
|
Service Code
|
HCPCS 28130
|
| Min. Negotiated Rate |
$511.30 |
| Max. Negotiated Rate |
$1,643.47 |
| Rate for Payer: Cash Price |
$720.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$730.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$657.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$657.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$693.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$730.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$693.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$730.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$730.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$547.82
|
| Rate for Payer: Healthfirst Commercial |
$730.43
|
| Rate for Payer: Healthfirst Essential Plan |
$1,643.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$693.91
|
| Rate for Payer: Healthfirst QHP |
$730.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$511.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$730.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$620.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$511.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$730.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$547.82
|
| Rate for Payer: SOMOS Essential |
$547.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$730.43
|
|
|
PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$90.16
|
|
|
Service Code
|
HCPCS 11103
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Cash Price |
$24.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.37
|
| Rate for Payer: Healthfirst Commercial |
$24.49
|
| Rate for Payer: Healthfirst Essential Plan |
$55.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.27
|
| Rate for Payer: Healthfirst QHP |
$24.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$17.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$24.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$20.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.37
|
| Rate for Payer: SOMOS Essential |
$18.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.49
|
|
|
PR TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$157.89
|
|
|
Service Code
|
HCPCS 11102
|
| Min. Negotiated Rate |
$29.38 |
| Max. Negotiated Rate |
$94.43 |
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$39.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$41.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$39.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.48
|
| Rate for Payer: Healthfirst Commercial |
$41.97
|
| Rate for Payer: Healthfirst Essential Plan |
$94.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.87
|
| Rate for Payer: Healthfirst QHP |
$41.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$29.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$41.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$35.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$29.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$41.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.48
|
| Rate for Payer: SOMOS Essential |
$31.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.97
|
|
|
PR TAP BLOCK BILATERAL BY CONTINUOUS INFUSION(S)
|
Professional
|
Both
|
$320.85
|
|
|
Service Code
|
HCPCS 64489
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$186.73 |
| Rate for Payer: Cash Price |
$85.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$82.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$74.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$74.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$78.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$82.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$78.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.24
|
| Rate for Payer: Healthfirst Commercial |
$82.99
|
| Rate for Payer: Healthfirst Essential Plan |
$186.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$78.84
|
| Rate for Payer: Healthfirst QHP |
$82.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$58.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$82.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$70.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$58.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$82.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$62.24
|
| Rate for Payer: SOMOS Essential |
$62.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.99
|
|
|
PR TAP BLOCK BILATERAL BY INJECTION(S)
|
Professional
|
Both
|
$276.36
|
|
|
Service Code
|
HCPCS 64488
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$150.16 |
| Rate for Payer: Cash Price |
$75.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$60.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$63.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$63.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.05
|
| Rate for Payer: Healthfirst Commercial |
$66.74
|
| Rate for Payer: Healthfirst Essential Plan |
$150.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$63.40
|
| Rate for Payer: Healthfirst QHP |
$66.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.05
|
| Rate for Payer: SOMOS Essential |
$50.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.74
|
|
|
PR TAP BLOCK UNILATERAL BY CONTINUOUS INFUSION(S)
|
Professional
|
Both
|
$257.01
|
|
|
Service Code
|
HCPCS 64487
|
| Min. Negotiated Rate |
$46.21 |
| Max. Negotiated Rate |
$148.52 |
| Rate for Payer: Cash Price |
$69.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$66.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$59.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$59.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$66.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$66.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.51
|
| Rate for Payer: Healthfirst Commercial |
$66.01
|
| Rate for Payer: Healthfirst Essential Plan |
$148.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.71
|
| Rate for Payer: Healthfirst QHP |
$66.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$46.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$66.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$56.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$46.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$49.51
|
| Rate for Payer: SOMOS Essential |
$49.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.01
|
|
|
PR TAP BLOCK UNILATERAL BY INJECTION(S)
|
Professional
|
Both
|
$225.09
|
|
|
Service Code
|
HCPCS 64486
|
| Min. Negotiated Rate |
$40.05 |
| Max. Negotiated Rate |
$128.75 |
| Rate for Payer: Cash Price |
$60.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.91
|
| Rate for Payer: Healthfirst Commercial |
$57.22
|
| Rate for Payer: Healthfirst Essential Plan |
$128.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.36
|
| Rate for Payer: Healthfirst QHP |
$57.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$48.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.91
|
| Rate for Payer: SOMOS Essential |
$42.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.22
|
|
