|
PR TRANSCOCHLR POST CRNL FOSSA W/WO MOBIL NRV/ART
|
Professional
|
Both
|
$10,511.59
|
|
|
Service Code
|
HCPCS 61596
|
| Min. Negotiated Rate |
$1,953.48 |
| Max. Negotiated Rate |
$6,279.03 |
| Rate for Payer: Cash Price |
$2,831.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,790.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,511.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,511.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,651.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,790.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,651.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,790.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,790.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,093.01
|
| Rate for Payer: Healthfirst Commercial |
$2,790.68
|
| Rate for Payer: Healthfirst Essential Plan |
$6,279.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,651.15
|
| Rate for Payer: Healthfirst QHP |
$2,790.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,953.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,790.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,372.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,953.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,790.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,093.01
|
| Rate for Payer: SOMOS Essential |
$2,093.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,790.68
|
|
|
PR TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ
|
Professional
|
Both
|
$454.13
|
|
|
Service Code
|
HCPCS 93893 TC
|
| Min. Negotiated Rate |
$121.24 |
| Max. Negotiated Rate |
$722.95 |
| Rate for Payer: Amida Care Medicaid |
$121.24
|
| Rate for Payer: Cash Price |
$406.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$321.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$289.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$289.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$305.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$321.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$305.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$321.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$321.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$240.98
|
| Rate for Payer: Healthfirst Commercial |
$321.31
|
| Rate for Payer: Healthfirst Essential Plan |
$722.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$305.24
|
| Rate for Payer: Healthfirst QHP |
$321.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$224.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$321.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$273.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$224.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$321.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$240.98
|
| Rate for Payer: SOMOS Essential |
$240.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$321.31
|
|
|
PR TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ
|
Professional
|
Both
|
$242.10
|
|
|
Service Code
|
HCPCS 93893 26
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$145.17 |
| Rate for Payer: Amida Care Medicaid |
$121.24
|
| Rate for Payer: Cash Price |
$65.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$58.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$61.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$61.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.39
|
| Rate for Payer: Healthfirst Commercial |
$64.52
|
| Rate for Payer: Healthfirst Essential Plan |
$145.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.29
|
| Rate for Payer: Healthfirst QHP |
$64.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$45.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$45.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.39
|
| Rate for Payer: SOMOS Essential |
$48.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.52
|
|
|
PR TRANSCRAN DOPPLER INTRACRAN ART MICROBUBBLE INJ
|
Professional
|
Both
|
$696.22
|
|
|
Service Code
|
HCPCS 93893
|
| Min. Negotiated Rate |
$121.24 |
| Max. Negotiated Rate |
$868.10 |
| Rate for Payer: Amida Care Medicaid |
$121.24
|
| Rate for Payer: Cash Price |
$472.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$385.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$347.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$347.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$366.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$385.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$366.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$385.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$385.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$289.37
|
| Rate for Payer: Healthfirst Commercial |
$385.82
|
| Rate for Payer: Healthfirst Essential Plan |
$868.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$366.53
|
| Rate for Payer: Healthfirst QHP |
$385.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$270.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$385.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$327.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$270.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$385.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$289.37
|
| Rate for Payer: SOMOS Essential |
$289.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$385.82
|
|
|
PR TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT
|
Professional
|
Both
|
$235.20
|
|
|
Service Code
|
HCPCS 93892 26
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$142.38 |
| Rate for Payer: Amida Care Medicaid |
$121.24
|
| Rate for Payer: Cash Price |
$64.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$63.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.46
|
| Rate for Payer: Healthfirst Commercial |
$63.28
|
| Rate for Payer: Healthfirst Essential Plan |
$142.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.12
|
| Rate for Payer: Healthfirst QHP |
$63.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$63.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$63.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.46
|
| Rate for Payer: SOMOS Essential |
$47.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$63.28
|
|
|
PR TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT
|
Professional
|
Both
|
$456.86
|
|
|
Service Code
|
HCPCS 93892 TC
|
| Min. Negotiated Rate |
$121.24 |
| Max. Negotiated Rate |
$616.90 |
| Rate for Payer: Amida Care Medicaid |
$121.24
|
| Rate for Payer: Cash Price |
$318.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$274.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$246.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$246.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$274.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$274.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$274.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.63
|
| Rate for Payer: Healthfirst Commercial |
$274.18
|
| Rate for Payer: Healthfirst Essential Plan |
$616.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$260.47
|
| Rate for Payer: Healthfirst QHP |
$274.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$274.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$233.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$274.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$205.63
|
| Rate for Payer: SOMOS Essential |
$205.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$274.18
|
|
|
PR TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT
|
Professional
|
Both
|
$692.06
|
|
|
Service Code
|
HCPCS 93892
|
| Min. Negotiated Rate |
$121.24 |
| Max. Negotiated Rate |
$759.28 |
| Rate for Payer: Amida Care Medicaid |
$121.24
|
| Rate for Payer: Cash Price |
$383.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$337.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$303.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$303.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$320.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$337.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$320.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$253.09
|
| Rate for Payer: Healthfirst Commercial |
$337.46
|
| Rate for Payer: Healthfirst Essential Plan |
$759.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$320.59
|
| Rate for Payer: Healthfirst QHP |
$337.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$236.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$337.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$286.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$236.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$337.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$253.09
|
| Rate for Payer: SOMOS Essential |
$253.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$337.46
|
|
|
PR TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY
|
Professional
|
Both
|
$199.43
|
|
|
Service Code
|
HCPCS 93890 26
|
| Rate for Payer: Cash Price |
$55.68
|
|
|
PR TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY
|
Professional
|
Both
|
$1,187.90
|
|
|
Service Code
|
HCPCS 93890
|
| Rate for Payer: Cash Price |
$332.22
|
|
|
PR TRANSCRANIAL DOPPLER INTRACRAN ART VASOREAC STDY
|
Professional
|
Both
|
$988.44
|
|
|
Service Code
|
HCPCS 93890 TC
|
| Rate for Payer: Cash Price |
$276.54
|
|
|
PR TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL
|
Professional
|
Both
|
$180.99
|
|
|
Service Code
|
HCPCS 93886 26
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Amida Care Medicaid |
$159.00
|
| Rate for Payer: Cash Price |
$50.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$49.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$44.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$49.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.75
|
| Rate for Payer: Healthfirst Commercial |
$49.00
|
| Rate for Payer: Healthfirst Essential Plan |
$110.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.55
|
| Rate for Payer: Healthfirst QHP |
$49.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$49.00
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.75
|
| Rate for Payer: SOMOS Essential |
$36.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.00
|
|
|
PR TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL
|
Professional
|
Both
|
$975.52
|
|
|
Service Code
|
HCPCS 93886 TC
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$555.25 |
| Rate for Payer: Amida Care Medicaid |
$159.00
|
| Rate for Payer: Cash Price |
$270.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$222.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$222.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$234.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$234.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$246.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.09
|
| Rate for Payer: Healthfirst Commercial |
$246.78
|
| Rate for Payer: Healthfirst Essential Plan |
$555.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$234.44
|
| Rate for Payer: Healthfirst QHP |
$246.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$172.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$246.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$209.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$172.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$185.09
|
| Rate for Payer: SOMOS Essential |
$185.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.78
|
|
|
PR TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL
|
Professional
|
Both
|
$1,156.47
|
|
|
Service Code
|
HCPCS 93886
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$665.53 |
| Rate for Payer: Amida Care Medicaid |
$159.00
|
| Rate for Payer: Cash Price |
$321.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$295.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$266.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$266.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$281.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$281.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$221.84
|
| Rate for Payer: Healthfirst Commercial |
$295.79
|
| Rate for Payer: Healthfirst Essential Plan |
$665.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$281.00
|
| Rate for Payer: Healthfirst QHP |
$295.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$207.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$295.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$251.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$207.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$295.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$221.84
|
| Rate for Payer: SOMOS Essential |
$221.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.79
|
|
|
PR TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD
|
Professional
|
Both
|
$559.16
|
|
|
Service Code
|
HCPCS 93888
|
| Min. Negotiated Rate |
$73.51 |
| Max. Negotiated Rate |
$417.76 |
| Rate for Payer: Amida Care Medicaid |
$73.51
|
| Rate for Payer: Cash Price |
$187.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$185.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$167.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$167.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$176.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$185.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$176.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$185.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$185.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.25
|
| Rate for Payer: Healthfirst Commercial |
$185.67
|
| Rate for Payer: Healthfirst Essential Plan |
$417.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$176.39
|
| Rate for Payer: Healthfirst QHP |
$185.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.97
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$185.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$185.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.25
|
| Rate for Payer: SOMOS Essential |
$139.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$185.67
|
|
|
PR TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD
|
Professional
|
Both
|
$456.86
|
|
|
Service Code
|
HCPCS 93888 TC
|
| Min. Negotiated Rate |
$73.51 |
| Max. Negotiated Rate |
$330.30 |
| Rate for Payer: Amida Care Medicaid |
$73.51
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.10
|
| Rate for Payer: Healthfirst Commercial |
$146.80
|
| Rate for Payer: Healthfirst Essential Plan |
$330.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$139.46
|
| Rate for Payer: Healthfirst QHP |
$146.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.10
|
| Rate for Payer: SOMOS Essential |
$110.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.80
|
|
|
PR TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD
|
Professional
|
Both
|
$102.31
|
|
|
Service Code
|
HCPCS 93888 26
|
| Min. Negotiated Rate |
$27.22 |
| Max. Negotiated Rate |
$87.48 |
| Rate for Payer: Amida Care Medicaid |
$73.51
|
| Rate for Payer: Cash Price |
$27.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.16
|
| Rate for Payer: Healthfirst Commercial |
$38.88
|
| Rate for Payer: Healthfirst Essential Plan |
$87.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.94
|
| Rate for Payer: Healthfirst QHP |
$38.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$27.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$38.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$33.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$27.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.16
|
| Rate for Payer: SOMOS Essential |
$29.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38.88
|
|
|
PR TRANSDUOL SPHINCTEROT/PLASTY W/WO RMVL CALCULUS
|
Professional
|
Both
|
$5,745.92
|
|
|
Service Code
|
HCPCS 47460
|
| Min. Negotiated Rate |
$1,061.85 |
| Max. Negotiated Rate |
$3,413.09 |
| Rate for Payer: Cash Price |
$1,529.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,516.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,365.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,365.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,441.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,516.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,441.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,516.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,516.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,137.70
|
| Rate for Payer: Healthfirst Commercial |
$1,516.93
|
| Rate for Payer: Healthfirst Essential Plan |
$3,413.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,441.08
|
| Rate for Payer: Healthfirst QHP |
$1,516.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,061.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,516.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,289.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,061.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,516.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,137.70
|
| Rate for Payer: SOMOS Essential |
$1,137.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,516.93
|
|
|
PR TRANSECTION/AVULSION FACIAL NRV DIFFERENT/CMPL
|
Professional
|
Both
|
$2,048.03
|
|
|
Service Code
|
HCPCS 64742
|
| Min. Negotiated Rate |
$392.17 |
| Max. Negotiated Rate |
$1,260.54 |
| Rate for Payer: Cash Price |
$564.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$560.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$504.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$504.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$532.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$560.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$532.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$560.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$560.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$420.18
|
| Rate for Payer: Healthfirst Commercial |
$560.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,260.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$532.23
|
| Rate for Payer: Healthfirst QHP |
$560.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$392.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$560.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$476.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$392.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$560.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$420.18
|
| Rate for Payer: SOMOS Essential |
$420.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$560.24
|
|
|
PR TRANSECTION/AVULSION GREATER OCCIPITAL NERVE
|
Professional
|
Both
|
$2,404.89
|
|
|
Service Code
|
HCPCS 64744
|
| Min. Negotiated Rate |
$445.96 |
| Max. Negotiated Rate |
$1,433.43 |
| Rate for Payer: Cash Price |
$641.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$637.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$573.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$573.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$605.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$637.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$605.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$637.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$637.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$477.81
|
| Rate for Payer: Healthfirst Commercial |
$637.08
|
| Rate for Payer: Healthfirst Essential Plan |
$1,433.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$605.23
|
| Rate for Payer: Healthfirst QHP |
$637.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$445.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$637.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$541.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$445.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$637.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$477.81
|
| Rate for Payer: SOMOS Essential |
$477.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$637.08
|
|
|
PR TRANSECTION/AVULSION INF ALVEOLAR NRV W/OSTEO
|
Professional
|
Both
|
$1,903.06
|
|
|
Service Code
|
HCPCS 64738
|
| Min. Negotiated Rate |
$360.66 |
| Max. Negotiated Rate |
$1,159.27 |
| Rate for Payer: Cash Price |
$517.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$515.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$463.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$463.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$489.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$515.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$489.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$515.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$515.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$386.42
|
| Rate for Payer: Healthfirst Commercial |
$515.23
|
| Rate for Payer: Healthfirst Essential Plan |
$1,159.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$489.47
|
| Rate for Payer: Healthfirst QHP |
$515.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$360.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$515.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$437.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$360.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$515.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$386.42
|
| Rate for Payer: SOMOS Essential |
$386.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$515.23
|
|
|
PR TRANSECTION/AVULSION INFRAORBITAL NERVE
|
Professional
|
Both
|
$2,431.87
|
|
|
Service Code
|
HCPCS 64734
|
| Min. Negotiated Rate |
$452.58 |
| Max. Negotiated Rate |
$1,454.71 |
| Rate for Payer: Cash Price |
$649.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$646.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$581.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$581.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$614.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$646.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$614.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$646.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$646.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$484.90
|
| Rate for Payer: Healthfirst Commercial |
$646.54
|
| Rate for Payer: Healthfirst Essential Plan |
$1,454.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$614.21
|
| Rate for Payer: Healthfirst QHP |
$646.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$452.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$646.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$549.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$452.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$646.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$484.90
|
| Rate for Payer: SOMOS Essential |
$484.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$646.54
|
|
|
PR TRANSECTION/AVULSION LINGUAL NERVE
|
Professional
|
Both
|
$1,950.34
|
|
|
Service Code
|
HCPCS 64740
|
| Min. Negotiated Rate |
$369.08 |
| Max. Negotiated Rate |
$1,186.34 |
| Rate for Payer: Cash Price |
$528.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$527.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$474.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$474.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$500.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$527.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$500.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$527.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$527.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$395.44
|
| Rate for Payer: Healthfirst Commercial |
$527.26
|
| Rate for Payer: Healthfirst Essential Plan |
$1,186.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$500.90
|
| Rate for Payer: Healthfirst QHP |
$527.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$369.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$527.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$448.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$369.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$527.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$395.44
|
| Rate for Payer: SOMOS Essential |
$395.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$527.26
|
|
|
PR TRANSECTION/AVULSION MENTAL NERVE
|
Professional
|
Both
|
$1,389.85
|
|
|
Service Code
|
HCPCS 64736
|
| Min. Negotiated Rate |
$269.21 |
| Max. Negotiated Rate |
$865.30 |
| Rate for Payer: Cash Price |
$380.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$384.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$346.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$346.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$365.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$384.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$365.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$384.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$384.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$288.44
|
| Rate for Payer: Healthfirst Commercial |
$384.58
|
| Rate for Payer: Healthfirst Essential Plan |
$865.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$365.35
|
| Rate for Payer: Healthfirst QHP |
$384.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$269.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$384.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$326.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$269.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$384.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$288.44
|
| Rate for Payer: SOMOS Essential |
$288.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$384.58
|
|
|
PR TRANSECTION/AVULSION OTH CRANIAL NRV XDRL
|
Professional
|
Both
|
$2,528.09
|
|
|
Service Code
|
HCPCS 64771
|
| Min. Negotiated Rate |
$502.72 |
| Max. Negotiated Rate |
$1,615.88 |
| Rate for Payer: Cash Price |
$688.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$718.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$646.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$646.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$682.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$718.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$682.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$718.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$718.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$538.63
|
| Rate for Payer: Healthfirst Commercial |
$718.17
|
| Rate for Payer: Healthfirst Essential Plan |
$1,615.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$682.26
|
| Rate for Payer: Healthfirst QHP |
$718.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$502.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$718.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$610.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$502.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$718.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$538.63
|
| Rate for Payer: SOMOS Essential |
$538.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$718.17
|
|
|
PR TRANSECTION/AVULSION OTH SPINAL NRV XDRL
|
Professional
|
Both
|
$2,477.13
|
|
|
Service Code
|
HCPCS 64772
|
| Min. Negotiated Rate |
$461.72 |
| Max. Negotiated Rate |
$1,484.10 |
| Rate for Payer: Cash Price |
$665.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$659.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$593.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$593.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$626.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$659.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$626.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$659.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$659.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$494.70
|
| Rate for Payer: Healthfirst Commercial |
$659.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,484.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$626.62
|
| Rate for Payer: Healthfirst QHP |
$659.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$461.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$659.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$560.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$461.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$659.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$494.70
|
| Rate for Payer: SOMOS Essential |
$494.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$659.60
|
|
