|
PR CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES
|
Professional
|
Both
|
$515.52
|
|
|
Service Code
|
HCPCS 64644
|
| Min. Negotiated Rate |
$95.98 |
| Max. Negotiated Rate |
$308.50 |
| Rate for Payer: Cash Price |
$138.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.83
|
| Rate for Payer: Healthfirst Commercial |
$137.11
|
| Rate for Payer: Healthfirst Essential Plan |
$308.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.25
|
| Rate for Payer: Healthfirst QHP |
$137.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$95.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$95.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$102.83
|
| Rate for Payer: SOMOS Essential |
$102.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.11
|
|
|
PR CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE
|
Professional
|
Both
|
$310.35
|
|
|
Service Code
|
HCPCS 64643
|
| Min. Negotiated Rate |
$56.49 |
| Max. Negotiated Rate |
$181.57 |
| Rate for Payer: Cash Price |
$82.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.52
|
| Rate for Payer: Healthfirst Commercial |
$80.70
|
| Rate for Payer: Healthfirst Essential Plan |
$181.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.67
|
| Rate for Payer: Healthfirst QHP |
$80.70
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.70
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.59
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.70
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.52
|
| Rate for Payer: SOMOS Essential |
$60.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.70
|
|
|
PR CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES
|
Professional
|
Both
|
$367.75
|
|
|
Service Code
|
HCPCS 64645
|
| Min. Negotiated Rate |
$67.36 |
| Max. Negotiated Rate |
$216.52 |
| Rate for Payer: Cash Price |
$97.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$96.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$96.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$96.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$96.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.17
|
| Rate for Payer: Healthfirst Commercial |
$96.23
|
| Rate for Payer: Healthfirst Essential Plan |
$216.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.42
|
| Rate for Payer: Healthfirst QHP |
$96.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$96.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$96.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.17
|
| Rate for Payer: SOMOS Essential |
$72.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$96.23
|
|
|
PR CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE
|
Professional
|
Both
|
$176.58
|
|
|
Service Code
|
HCPCS 64650
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$105.89 |
| Rate for Payer: Cash Price |
$47.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$42.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$42.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$44.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$44.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.30
|
| Rate for Payer: Healthfirst Commercial |
$47.06
|
| Rate for Payer: Healthfirst Essential Plan |
$105.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.71
|
| Rate for Payer: Healthfirst QHP |
$47.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$32.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$47.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$40.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$35.30
|
| Rate for Payer: SOMOS Essential |
$35.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.06
|
|
|
PR CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY
|
Professional
|
Both
|
$228.48
|
|
|
Service Code
|
HCPCS 64653
|
| Min. Negotiated Rate |
$41.89 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: Cash Price |
$61.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$53.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$56.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$59.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$56.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.88
|
| Rate for Payer: Healthfirst Commercial |
$59.84
|
| Rate for Payer: Healthfirst Essential Plan |
$134.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$56.85
|
| Rate for Payer: Healthfirst QHP |
$59.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$41.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$41.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$59.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.88
|
| Rate for Payer: SOMOS Essential |
$44.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$59.84
|
|
|
PR CHEMODENERVATION EXTRAOCULAR MUSCLE
|
Professional
|
Both
|
$913.12
|
|
|
Service Code
|
HCPCS 67345
|
| Min. Negotiated Rate |
$176.27 |
| Max. Negotiated Rate |
$566.60 |
| Rate for Payer: Cash Price |
$249.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$251.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$226.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$226.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$251.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$188.87
|
| Rate for Payer: Healthfirst Commercial |
$251.82
|
| Rate for Payer: Healthfirst Essential Plan |
$566.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.23
|
| Rate for Payer: Healthfirst QHP |
$251.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$251.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$251.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$188.87
|
| Rate for Payer: SOMOS Essential |
$188.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$251.82
|
|
|
PR CHEMODENERVATION INTERNAL ANAL SPHINCTER
|
Professional
|
Both
|
$1,095.01
|
|
|
Service Code
|
HCPCS 46505
|
| Min. Negotiated Rate |
$203.84 |
| Max. Negotiated Rate |
$655.20 |
| Rate for Payer: Cash Price |
$295.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$291.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$262.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$262.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$276.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$291.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$276.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$291.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$218.40
|
| Rate for Payer: Healthfirst Commercial |
$291.20
|
| Rate for Payer: Healthfirst Essential Plan |
$655.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$276.64
|
| Rate for Payer: Healthfirst QHP |
$291.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$203.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$291.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$247.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$203.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$291.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$218.40
|
| Rate for Payer: SOMOS Essential |
$218.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$291.20
|
|
|
PR CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG
|
Professional
|
Both
|
$464.21
|
|
|
Service Code
|
HCPCS 64617
|
| Min. Negotiated Rate |
$87.28 |
| Max. Negotiated Rate |
$280.53 |
| Rate for Payer: Cash Price |
$125.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.51
|
| Rate for Payer: Healthfirst Commercial |
$124.68
|
| Rate for Payer: Healthfirst Essential Plan |
$280.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.45
|
| Rate for Payer: Healthfirst QHP |
$124.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$105.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.51
|
| Rate for Payer: SOMOS Essential |
$93.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.68
|
|
|
PR CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA
|
Professional
|
Both
|
$505.12
|
|
|
Service Code
|
HCPCS 64616
|
| Min. Negotiated Rate |
$94.17 |
| Max. Negotiated Rate |
$302.69 |
| Rate for Payer: Cash Price |
$135.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.90
|
| Rate for Payer: Healthfirst Commercial |
$134.53
|
| Rate for Payer: Healthfirst Essential Plan |
$302.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.80
|
| Rate for Payer: Healthfirst QHP |
$134.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.90
|
| Rate for Payer: SOMOS Essential |
$100.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.53
|
|
|
PR CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES
|
Professional
|
Both
|
$609.70
|
|
|
Service Code
|
HCPCS 64647
|
| Min. Negotiated Rate |
$110.82 |
| Max. Negotiated Rate |
$356.20 |
| Rate for Payer: Cash Price |
$162.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$158.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$142.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$150.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$158.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.73
|
| Rate for Payer: Healthfirst Commercial |
$158.31
|
| Rate for Payer: Healthfirst Essential Plan |
$356.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.39
|
| Rate for Payer: Healthfirst QHP |
$158.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$110.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$158.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$134.56
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$110.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$158.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.73
|
| Rate for Payer: SOMOS Essential |
$118.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.31
|
|
|
PR CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES
|
Professional
|
Both
|
$526.26
|
|
|
Service Code
|
HCPCS 64646
|
| Min. Negotiated Rate |
$98.19 |
| Max. Negotiated Rate |
$315.61 |
| Rate for Payer: Cash Price |
$140.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.20
|
| Rate for Payer: Healthfirst Commercial |
$140.27
|
| Rate for Payer: Healthfirst Essential Plan |
$315.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.26
|
| Rate for Payer: Healthfirst QHP |
$140.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.20
|
| Rate for Payer: SOMOS Essential |
$105.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.27
|
|
|
PR CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE
|
Professional
|
Both
|
$473.06
|
|
|
Service Code
|
HCPCS 64642
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$286.06 |
| Rate for Payer: Cash Price |
$128.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$114.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$114.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.36
|
| Rate for Payer: Healthfirst Commercial |
$127.14
|
| Rate for Payer: Healthfirst Essential Plan |
$286.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.78
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$89.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$127.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$108.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$89.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.36
|
| Rate for Payer: SOMOS Essential |
$95.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
|
|
PR CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS
|
Professional
|
Both
|
$508.97
|
|
|
Service Code
|
HCPCS 64611
|
| Min. Negotiated Rate |
$96.33 |
| Max. Negotiated Rate |
$309.62 |
| Rate for Payer: Cash Price |
$139.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$137.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$130.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$130.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.21
|
| Rate for Payer: Healthfirst Commercial |
$137.61
|
| Rate for Payer: Healthfirst Essential Plan |
$309.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$130.73
|
| Rate for Payer: Healthfirst QHP |
$137.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$137.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$116.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$137.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.21
|
| Rate for Payer: SOMOS Essential |
$103.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$137.61
|
|
|
PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
|
Professional
|
Both
|
$579.18
|
|
|
Service Code
|
HCPCS 64615
|
| Min. Negotiated Rate |
$105.29 |
| Max. Negotiated Rate |
$338.44 |
| Rate for Payer: Cash Price |
$151.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.81
|
| Rate for Payer: Healthfirst Commercial |
$150.42
|
| Rate for Payer: Healthfirst Essential Plan |
$338.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.90
|
| Rate for Payer: Healthfirst QHP |
$150.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.81
|
| Rate for Payer: SOMOS Essential |
$112.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.42
|
|
|
PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL
|
Professional
|
Both
|
$520.45
|
|
|
Service Code
|
HCPCS 64612
|
| Min. Negotiated Rate |
$98.17 |
| Max. Negotiated Rate |
$315.56 |
| Rate for Payer: Cash Price |
$142.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.19
|
| Rate for Payer: Healthfirst Commercial |
$140.25
|
| Rate for Payer: Healthfirst Essential Plan |
$315.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.24
|
| Rate for Payer: Healthfirst QHP |
$140.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.19
|
| Rate for Payer: SOMOS Essential |
$105.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.25
|
|
|
PR CHEMOTHERAPY ADMIN INTRA-ARTERIAL INFUS <1 HR
|
Professional
|
Both
|
$688.35
|
|
|
Service Code
|
HCPCS 96422
|
| Min. Negotiated Rate |
$121.95 |
| Max. Negotiated Rate |
$392.00 |
| Rate for Payer: Cash Price |
$185.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$174.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$156.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$156.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$165.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$174.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$165.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$174.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$174.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.66
|
| Rate for Payer: Healthfirst Commercial |
$174.22
|
| Rate for Payer: Healthfirst Essential Plan |
$392.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$165.51
|
| Rate for Payer: Healthfirst QHP |
$174.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$121.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$174.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$148.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$121.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$174.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$130.66
|
| Rate for Payer: SOMOS Essential |
$130.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$174.22
|
|
|
PR CHEMOTHERAPY ADMIN INTRA-ARTERIAL PUSH TQ
|
Professional
|
Both
|
$445.97
|
|
|
Service Code
|
HCPCS 96420
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$255.94 |
| Rate for Payer: Cash Price |
$120.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$108.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$108.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.31
|
| Rate for Payer: Healthfirst Commercial |
$113.75
|
| Rate for Payer: Healthfirst Essential Plan |
$255.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$108.06
|
| Rate for Payer: Healthfirst QHP |
$113.75
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.75
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.31
|
| Rate for Payer: SOMOS Essential |
$85.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.75
|
|
|
PR CHEMOTHERAPY ADMINISTRATION INTRALESIONAL </7
|
Professional
|
Both
|
$119.21
|
|
|
Service Code
|
HCPCS 96405
|
| Min. Negotiated Rate |
$22.26 |
| Max. Negotiated Rate |
$71.55 |
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.85
|
| Rate for Payer: Healthfirst Commercial |
$31.80
|
| Rate for Payer: Healthfirst Essential Plan |
$71.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$30.21
|
| Rate for Payer: Healthfirst QHP |
$31.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$22.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$31.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$27.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$22.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.85
|
| Rate for Payer: SOMOS Essential |
$23.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.80
|
|
|
PR CHEMOTHERAPY ADMINISTRATION INTRALESIONAL >7
|
Professional
|
Both
|
$182.74
|
|
|
Service Code
|
HCPCS 96406
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: Cash Price |
$49.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$46.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$46.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.49
|
| Rate for Payer: Healthfirst Commercial |
$48.66
|
| Rate for Payer: Healthfirst Essential Plan |
$109.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.23
|
| Rate for Payer: Healthfirst QHP |
$48.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$34.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$48.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$41.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$34.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.49
|
| Rate for Payer: SOMOS Essential |
$36.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$48.66
|
|
|
PR CHEMOTHERAPY ADMN INTRAARTERIAL INFUSION EA HR
|
Professional
|
Both
|
$315.42
|
|
|
Service Code
|
HCPCS 96423
|
| Min. Negotiated Rate |
$56.37 |
| Max. Negotiated Rate |
$181.19 |
| Rate for Payer: Cash Price |
$86.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$72.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$76.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$76.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.40
|
| Rate for Payer: Healthfirst Commercial |
$80.53
|
| Rate for Payer: Healthfirst Essential Plan |
$181.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$76.50
|
| Rate for Payer: Healthfirst QHP |
$80.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$80.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.40
|
| Rate for Payer: SOMOS Essential |
$60.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80.53
|
|
|
PR CHEMOTHERAPY ADMN IV INFUSION TQ EA HR
|
Professional
|
Both
|
$119.84
|
|
|
Service Code
|
HCPCS 96415
|
| Min. Negotiated Rate |
$21.04 |
| Max. Negotiated Rate |
$67.64 |
| Rate for Payer: Cash Price |
$32.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.55
|
| Rate for Payer: Healthfirst Commercial |
$30.06
|
| Rate for Payer: Healthfirst Essential Plan |
$67.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.56
|
| Rate for Payer: Healthfirst QHP |
$30.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.06
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.55
|
| Rate for Payer: SOMOS Essential |
$22.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.06
|
|
|
PR CHEMOTX ADMN CNS REQ SPINAL PUNCTURE
|
Professional
|
Both
|
$316.19
|
|
|
Service Code
|
HCPCS 96450
|
| Min. Negotiated Rate |
$59.96 |
| Max. Negotiated Rate |
$192.74 |
| Rate for Payer: Cash Price |
$85.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$85.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$77.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$85.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.25
|
| Rate for Payer: Healthfirst Commercial |
$85.66
|
| Rate for Payer: Healthfirst Essential Plan |
$192.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$81.38
|
| Rate for Payer: Healthfirst QHP |
$85.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$59.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$85.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$72.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$59.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$85.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$64.25
|
| Rate for Payer: SOMOS Essential |
$64.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.66
|
|
|
PR CHEMOTX ADMN IA NFS >8 HR PRTBLE IMPLTBL PMP
|
Professional
|
Both
|
$738.50
|
|
|
Service Code
|
HCPCS 96425
|
| Min. Negotiated Rate |
$131.51 |
| Max. Negotiated Rate |
$422.71 |
| Rate for Payer: Cash Price |
$200.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$187.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$169.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$169.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$178.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$187.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$178.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$187.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$187.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.90
|
| Rate for Payer: Healthfirst Commercial |
$187.87
|
| Rate for Payer: Healthfirst Essential Plan |
$422.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$178.48
|
| Rate for Payer: Healthfirst QHP |
$187.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$131.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$187.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$159.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$131.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$187.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$140.90
|
| Rate for Payer: SOMOS Essential |
$140.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$187.87
|
|
|
PR CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR
|
Professional
|
Both
|
$277.31
|
|
|
Service Code
|
HCPCS 96417
|
| Min. Negotiated Rate |
$49.29 |
| Max. Negotiated Rate |
$158.44 |
| Rate for Payer: Cash Price |
$75.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$63.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$63.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$66.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$66.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.81
|
| Rate for Payer: Healthfirst Commercial |
$70.42
|
| Rate for Payer: Healthfirst Essential Plan |
$158.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.90
|
| Rate for Payer: Healthfirst QHP |
$70.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$49.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$59.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$49.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$52.81
|
| Rate for Payer: SOMOS Essential |
$52.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.42
|
|
|
PR CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG
|
Professional
|
Both
|
$564.55
|
|
|
Service Code
|
HCPCS 96413
|
| Min. Negotiated Rate |
$100.37 |
| Max. Negotiated Rate |
$322.63 |
| Rate for Payer: Cash Price |
$152.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$143.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$129.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.54
|
| Rate for Payer: Healthfirst Commercial |
$143.39
|
| Rate for Payer: Healthfirst Essential Plan |
$322.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.22
|
| Rate for Payer: Healthfirst QHP |
$143.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.54
|
| Rate for Payer: SOMOS Essential |
$107.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.39
|
|
