|
PR CRANIOT LOBEC TEMPORAL LOBE W/ELECTROCORTCOGRPHY
|
Professional
|
Both
|
$12,862.78
|
|
|
Service Code
|
HCPCS 61538
|
| Min. Negotiated Rate |
$2,342.59 |
| Max. Negotiated Rate |
$7,529.74 |
| Rate for Payer: Cash Price |
$3,381.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,346.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,011.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,011.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,179.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,346.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,179.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,346.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,346.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,509.91
|
| Rate for Payer: Healthfirst Commercial |
$3,346.55
|
| Rate for Payer: Healthfirst Essential Plan |
$7,529.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,179.22
|
| Rate for Payer: Healthfirst QHP |
$3,346.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,342.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,346.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,844.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,342.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,346.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,509.91
|
| Rate for Payer: SOMOS Essential |
$2,509.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,346.55
|
|
|
PR CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/ECOG
|
Professional
|
Both
|
$11,403.49
|
|
|
Service Code
|
HCPCS 61539
|
| Min. Negotiated Rate |
$2,080.81 |
| Max. Negotiated Rate |
$6,688.31 |
| Rate for Payer: Cash Price |
$3,001.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,972.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,675.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,675.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,823.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,972.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,823.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,972.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,972.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,229.43
|
| Rate for Payer: Healthfirst Commercial |
$2,972.58
|
| Rate for Payer: Healthfirst Essential Plan |
$6,688.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,823.95
|
| Rate for Payer: Healthfirst QHP |
$2,972.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,080.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,972.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,526.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,080.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,972.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,229.43
|
| Rate for Payer: SOMOS Essential |
$2,229.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,972.58
|
|
|
PR CRANIOT LOBECTOMY OTH/THN TEMPORAL LOBE W/O ECOG
|
Professional
|
Both
|
$10,511.90
|
|
|
Service Code
|
HCPCS 61540
|
| Min. Negotiated Rate |
$1,918.80 |
| Max. Negotiated Rate |
$6,167.56 |
| Rate for Payer: Cash Price |
$2,769.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,741.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,467.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,467.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,604.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,741.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,604.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,741.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,741.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,055.86
|
| Rate for Payer: Healthfirst Commercial |
$2,741.14
|
| Rate for Payer: Healthfirst Essential Plan |
$6,167.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,604.08
|
| Rate for Payer: Healthfirst QHP |
$2,741.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,918.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,741.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,329.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,918.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,741.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,055.86
|
| Rate for Payer: SOMOS Essential |
$2,055.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,741.14
|
|
|
PR CRANIOTOMY EXCISION/COAGULATION CHOROID PLEXUS
|
Professional
|
Both
|
$9,169.76
|
|
|
Service Code
|
HCPCS 61544
|
| Min. Negotiated Rate |
$1,675.74 |
| Max. Negotiated Rate |
$5,386.30 |
| Rate for Payer: Cash Price |
$2,417.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,393.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,154.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,154.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,274.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,393.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,274.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,393.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,393.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,795.43
|
| Rate for Payer: Healthfirst Commercial |
$2,393.91
|
| Rate for Payer: Healthfirst Essential Plan |
$5,386.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,274.21
|
| Rate for Payer: Healthfirst QHP |
$2,393.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,675.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,393.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,034.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,675.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,393.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,795.43
|
| Rate for Payer: SOMOS Essential |
$1,795.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,393.91
|
|
|
PR CRANIOTOMY EXCISION CRANIOPHARYNGIOMA
|
Professional
|
Both
|
$15,386.81
|
|
|
Service Code
|
HCPCS 61545
|
| Min. Negotiated Rate |
$2,806.86 |
| Max. Negotiated Rate |
$9,022.05 |
| Rate for Payer: Cash Price |
$4,048.97
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,009.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,608.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,608.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,809.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,009.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,809.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,009.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,009.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,007.35
|
| Rate for Payer: Healthfirst Commercial |
$4,009.80
|
| Rate for Payer: Healthfirst Essential Plan |
$9,022.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,809.31
|
| Rate for Payer: Healthfirst QHP |
$4,009.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,806.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,009.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,408.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,806.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,009.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,007.35
|
| Rate for Payer: SOMOS Essential |
$3,007.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,009.80
|
|
|
PR CRANIOTOMY FOR ENCEPHALOCELE REPAIR SKULL BASE
|
Professional
|
Both
|
$7,064.79
|
|
|
Service Code
|
HCPCS 62121
|
| Min. Negotiated Rate |
$1,293.96 |
| Max. Negotiated Rate |
$4,159.15 |
| Rate for Payer: Cash Price |
$1,885.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,848.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,663.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,663.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,756.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,848.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,756.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,848.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,848.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,386.38
|
| Rate for Payer: Healthfirst Commercial |
$1,848.51
|
| Rate for Payer: Healthfirst Essential Plan |
$4,159.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,756.08
|
| Rate for Payer: Healthfirst QHP |
$1,848.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,293.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,848.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,571.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,293.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,848.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,386.38
|
| Rate for Payer: SOMOS Essential |
$1,386.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,848.51
|
|
|
PR CRANIOTOMY MULTIPLE SUBPIAL TRANSECTIONS W/ECOG
|
Professional
|
Both
|
$12,324.13
|
|
|
Service Code
|
HCPCS 61567
|
| Min. Negotiated Rate |
$2,250.02 |
| Max. Negotiated Rate |
$7,232.20 |
| Rate for Payer: Cash Price |
$3,245.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,214.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,892.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,892.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,053.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,214.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,053.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,214.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,214.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,410.73
|
| Rate for Payer: Healthfirst Commercial |
$3,214.31
|
| Rate for Payer: Healthfirst Essential Plan |
$7,232.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,053.59
|
| Rate for Payer: Healthfirst QHP |
$3,214.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,250.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,214.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,732.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,250.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,214.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,410.73
|
| Rate for Payer: SOMOS Essential |
$2,410.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,214.31
|
|
|
PR CRANIOTOMY PARTIAL/SUBTOTAL HEMISPHERECTOMY
|
Professional
|
Both
|
$10,497.59
|
|
|
Service Code
|
HCPCS 61543
|
| Min. Negotiated Rate |
$1,918.03 |
| Max. Negotiated Rate |
$6,165.09 |
| Rate for Payer: Cash Price |
$2,765.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,740.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,466.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,466.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,603.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,740.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,603.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,740.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,740.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,055.03
|
| Rate for Payer: Healthfirst Commercial |
$2,740.04
|
| Rate for Payer: Healthfirst Essential Plan |
$6,165.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,603.04
|
| Rate for Payer: Healthfirst QHP |
$2,740.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,918.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,740.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,329.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,918.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,740.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,055.03
|
| Rate for Payer: SOMOS Essential |
$2,055.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,740.04
|
|
|
PR CRANIOTOMY SELECTIVE AMYGDALOHIPPOCAMPECTOMY
|
Professional
|
Both
|
$10,819.55
|
|
|
Service Code
|
HCPCS 61566
|
| Min. Negotiated Rate |
$1,974.72 |
| Max. Negotiated Rate |
$6,347.32 |
| Rate for Payer: Cash Price |
$2,849.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,821.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,538.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,538.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,679.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,821.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,679.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,821.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,821.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,115.77
|
| Rate for Payer: Healthfirst Commercial |
$2,821.03
|
| Rate for Payer: Healthfirst Essential Plan |
$6,347.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,679.98
|
| Rate for Payer: Healthfirst QHP |
$2,821.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,974.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,821.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,397.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,974.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,821.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,115.77
|
| Rate for Payer: SOMOS Essential |
$2,115.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,821.03
|
|
|
PR CRANIOTOMY TRANSECTION CORPUS CALLOSUM
|
Professional
|
Both
|
$10,389.79
|
|
|
Service Code
|
HCPCS 61541
|
| Min. Negotiated Rate |
$1,897.29 |
| Max. Negotiated Rate |
$6,098.44 |
| Rate for Payer: Cash Price |
$2,735.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,710.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,439.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,439.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,574.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,710.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,574.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,710.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,710.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,032.82
|
| Rate for Payer: Healthfirst Commercial |
$2,710.42
|
| Rate for Payer: Healthfirst Essential Plan |
$6,098.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,574.90
|
| Rate for Payer: Healthfirst QHP |
$2,710.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,897.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,710.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,303.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,897.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,710.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,032.82
|
| Rate for Payer: SOMOS Essential |
$2,032.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,710.42
|
|
|
PR CRANIOT RMVL EPID/SUBDURL ELCTRD W/O EXC TIS SPX
|
Professional
|
Both
|
$4,830.67
|
|
|
Service Code
|
HCPCS 61535
|
| Min. Negotiated Rate |
$890.13 |
| Max. Negotiated Rate |
$2,861.12 |
| Rate for Payer: Cash Price |
$1,281.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,271.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,144.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,144.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,208.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,271.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,208.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,271.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,271.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$953.71
|
| Rate for Payer: Healthfirst Commercial |
$1,271.61
|
| Rate for Payer: Healthfirst Essential Plan |
$2,861.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,208.03
|
| Rate for Payer: Healthfirst QHP |
$1,271.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$890.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,271.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,080.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$890.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,271.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$953.71
|
| Rate for Payer: SOMOS Essential |
$953.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,271.61
|
|
|
PR CRANIOT SUBDURAL IMPLT ELCTRD SEIZURE MONITORING
|
Professional
|
Both
|
$7,371.32
|
|
|
Service Code
|
HCPCS 61533
|
| Min. Negotiated Rate |
$1,349.52 |
| Max. Negotiated Rate |
$4,337.73 |
| Rate for Payer: Cash Price |
$1,945.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,927.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,735.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,735.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,831.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,927.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,831.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,927.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,927.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,445.91
|
| Rate for Payer: Healthfirst Commercial |
$1,927.88
|
| Rate for Payer: Healthfirst Essential Plan |
$4,337.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,831.49
|
| Rate for Payer: Healthfirst QHP |
$1,927.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,349.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,927.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,638.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,349.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,927.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,445.91
|
| Rate for Payer: SOMOS Essential |
$1,445.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,927.88
|
|
|
PR CRANIOT TEMPORAL LOBE W/O ELECTROCORTICOGRAPHY
|
Professional
|
Both
|
$11,888.45
|
|
|
Service Code
|
HCPCS 61537
|
| Min. Negotiated Rate |
$2,165.18 |
| Max. Negotiated Rate |
$6,959.50 |
| Rate for Payer: Cash Price |
$3,123.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,093.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,783.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,783.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,938.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,093.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,938.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,093.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,093.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,319.83
|
| Rate for Payer: Healthfirst Commercial |
$3,093.11
|
| Rate for Payer: Healthfirst Essential Plan |
$6,959.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,938.45
|
| Rate for Payer: Healthfirst QHP |
$3,093.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,165.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,093.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,629.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,165.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,093.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,319.83
|
| Rate for Payer: SOMOS Essential |
$2,319.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,093.11
|
|
|
PR CREATE LESION STRTCTC PRQ NEUROLYTIC GASSERIAN
|
Professional
|
Both
|
$4,239.17
|
|
|
Service Code
|
HCPCS 61790
|
| Min. Negotiated Rate |
$780.02 |
| Max. Negotiated Rate |
$2,507.22 |
| Rate for Payer: Cash Price |
$1,119.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,114.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,002.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,002.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,058.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,114.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,058.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,114.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,114.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$835.74
|
| Rate for Payer: Healthfirst Commercial |
$1,114.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,507.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,058.60
|
| Rate for Payer: Healthfirst QHP |
$1,114.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$780.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,114.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$947.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$780.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,114.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$835.74
|
| Rate for Payer: SOMOS Essential |
$835.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,114.32
|
|
|
PR CREATE LES STRTCTC PRQ NEUROLYTIC TRIGEMINAL TRC
|
Professional
|
Both
|
$5,434.49
|
|
|
Service Code
|
HCPCS 61791
|
| Min. Negotiated Rate |
$998.39 |
| Max. Negotiated Rate |
$3,209.11 |
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,426.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,283.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,283.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,354.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,426.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,354.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,426.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,426.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,069.70
|
| Rate for Payer: Healthfirst Commercial |
$1,426.27
|
| Rate for Payer: Healthfirst Essential Plan |
$3,209.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,354.96
|
| Rate for Payer: Healthfirst QHP |
$1,426.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$998.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,426.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,212.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$998.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,426.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,069.70
|
| Rate for Payer: SOMOS Essential |
$1,069.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,426.27
|
|
|
PR CREATION LES SPINAL CORD STEREOTACTIC METHOD PRQ
|
Professional
|
Both
|
$5,274.75
|
|
|
Service Code
|
HCPCS 63600
|
| Min. Negotiated Rate |
$970.17 |
| Max. Negotiated Rate |
$3,118.41 |
| Rate for Payer: Cash Price |
$1,394.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,385.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,247.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,247.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,316.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,385.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,316.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,385.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,385.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,039.47
|
| Rate for Payer: Healthfirst Commercial |
$1,385.96
|
| Rate for Payer: Healthfirst Essential Plan |
$3,118.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,316.66
|
| Rate for Payer: Healthfirst QHP |
$1,385.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$970.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,385.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,178.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$970.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,385.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,039.47
|
| Rate for Payer: SOMOS Essential |
$1,039.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,385.96
|
|
|
PR CRICOPHARYNGEAL MYOTOMY
|
Professional
|
Both
|
$2,269.19
|
|
|
Service Code
|
HCPCS 43030
|
| Min. Negotiated Rate |
$427.83 |
| Max. Negotiated Rate |
$1,375.18 |
| Rate for Payer: Cash Price |
$616.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$611.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$550.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$550.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$580.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$611.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$580.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$611.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$611.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$458.39
|
| Rate for Payer: Healthfirst Commercial |
$611.19
|
| Rate for Payer: Healthfirst Essential Plan |
$1,375.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$580.63
|
| Rate for Payer: Healthfirst QHP |
$611.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$427.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$611.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$519.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$427.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$611.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$458.39
|
| Rate for Payer: SOMOS Essential |
$458.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$611.19
|
|
|
PR CRICOTRACHEAL RESECTION
|
Professional
|
Both
|
$7,488.99
|
|
|
Service Code
|
HCPCS 31592
|
| Min. Negotiated Rate |
$1,400.30 |
| Max. Negotiated Rate |
$4,500.97 |
| Rate for Payer: Cash Price |
$2,020.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,000.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,800.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,800.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,900.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,000.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,900.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,000.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,000.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,500.32
|
| Rate for Payer: Healthfirst Commercial |
$2,000.43
|
| Rate for Payer: Healthfirst Essential Plan |
$4,500.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,900.41
|
| Rate for Payer: Healthfirst QHP |
$2,000.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,400.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,000.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,700.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,400.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,000.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,500.32
|
| Rate for Payer: SOMOS Essential |
$1,500.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,000.43
|
|
|
PR CRIT CARE TELEHEA CONSULT 50
|
Professional
|
Both
|
$771.09
|
|
|
Service Code
|
HCPCS G0509
|
| Min. Negotiated Rate |
$146.27 |
| Max. Negotiated Rate |
$470.16 |
| Rate for Payer: Cash Price |
$212.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$208.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$208.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.72
|
| Rate for Payer: Healthfirst Commercial |
$208.96
|
| Rate for Payer: Healthfirst Essential Plan |
$470.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.51
|
| Rate for Payer: Healthfirst QHP |
$208.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$208.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$208.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.72
|
| Rate for Payer: SOMOS Essential |
$156.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.96
|
|
|
PR CRIT CARE TELEHEA CONSULT 60
|
Professional
|
Both
|
$845.57
|
|
|
Service Code
|
HCPCS G0508
|
| Min. Negotiated Rate |
$160.78 |
| Max. Negotiated Rate |
$516.80 |
| Rate for Payer: Cash Price |
$230.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$229.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$206.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$229.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.27
|
| Rate for Payer: Healthfirst Commercial |
$229.69
|
| Rate for Payer: Healthfirst Essential Plan |
$516.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.21
|
| Rate for Payer: Healthfirst QHP |
$229.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$160.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$229.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$195.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$160.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$229.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.27
|
| Rate for Payer: SOMOS Essential |
$172.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$229.69
|
|
|
PR CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN
|
Professional
|
Both
|
$442.61
|
|
|
Service Code
|
HCPCS 99292
|
| Min. Negotiated Rate |
$82.91 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Cash Price |
$120.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$118.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$106.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$112.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$118.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.83
|
| Rate for Payer: Healthfirst Commercial |
$118.44
|
| Rate for Payer: Healthfirst Essential Plan |
$266.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.52
|
| Rate for Payer: Healthfirst QHP |
$118.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$82.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$100.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$82.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$88.83
|
| Rate for Payer: SOMOS Essential |
$88.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.44
|
|
|
PR CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN
|
Professional
|
Both
|
$878.36
|
|
|
Service Code
|
HCPCS 99291
|
| Min. Negotiated Rate |
$84.68 |
| Max. Negotiated Rate |
$534.01 |
| Rate for Payer: Amida Care Medicaid |
$84.68
|
| Rate for Payer: Cash Price |
$237.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$237.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$213.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$225.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$237.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$225.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$237.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$178.00
|
| Rate for Payer: Healthfirst Commercial |
$237.34
|
| Rate for Payer: Healthfirst Essential Plan |
$534.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.47
|
| Rate for Payer: Healthfirst QHP |
$237.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$166.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$237.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$201.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$166.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$237.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$178.00
|
| Rate for Payer: SOMOS Essential |
$178.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$237.34
|
|
|
PR CRITICAL CARE INTERFACILITY TRANSPORT 30-74 MIN
|
Professional
|
Both
|
$934.89
|
|
|
Service Code
|
HCPCS 99466
|
| Min. Negotiated Rate |
$95.62 |
| Max. Negotiated Rate |
$567.38 |
| Rate for Payer: Amida Care Medicaid |
$95.62
|
| Rate for Payer: Cash Price |
$256.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$252.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$226.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$226.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$252.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$252.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.13
|
| Rate for Payer: Healthfirst Commercial |
$252.17
|
| Rate for Payer: Healthfirst Essential Plan |
$567.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.56
|
| Rate for Payer: Healthfirst QHP |
$252.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$252.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$252.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189.13
|
| Rate for Payer: SOMOS Essential |
$189.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$252.17
|
|
|
PR CRITICAL CARE INTERFACILITY TRANSPORT EA 30 MIN
|
Professional
|
Both
|
$476.35
|
|
|
Service Code
|
HCPCS 99467
|
| Min. Negotiated Rate |
$47.72 |
| Max. Negotiated Rate |
$284.26 |
| Rate for Payer: Amida Care Medicaid |
$47.72
|
| Rate for Payer: Cash Price |
$128.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$120.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$120.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.75
|
| Rate for Payer: Healthfirst Commercial |
$126.34
|
| Rate for Payer: Healthfirst Essential Plan |
$284.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$120.02
|
| Rate for Payer: Healthfirst QHP |
$126.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.75
|
| Rate for Payer: SOMOS Essential |
$94.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.34
|
|
|
PR CRNEC/CRX IMPLTJ NSTIM ELTRD CERE CORTICAL
|
Professional
|
Both
|
$7,553.32
|
|
|
Service Code
|
HCPCS 61860
|
| Min. Negotiated Rate |
$1,380.76 |
| Max. Negotiated Rate |
$4,438.15 |
| Rate for Payer: Cash Price |
$1,990.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,972.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,775.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,775.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,873.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,972.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,873.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,972.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,972.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,479.38
|
| Rate for Payer: Healthfirst Commercial |
$1,972.51
|
| Rate for Payer: Healthfirst Essential Plan |
$4,438.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,873.88
|
| Rate for Payer: Healthfirst QHP |
$1,972.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,380.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,972.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,676.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,380.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,972.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,479.38
|
| Rate for Payer: SOMOS Essential |
$1,479.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,972.51
|
|
