|
PR EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK
|
Professional
|
Both
|
$2,663.19
|
|
|
Service Code
|
HCPCS 61623
|
| Min. Negotiated Rate |
$488.59 |
| Max. Negotiated Rate |
$1,570.45 |
| Rate for Payer: Cash Price |
$704.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$697.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$628.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$628.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$663.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$697.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$663.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$697.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$697.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$523.49
|
| Rate for Payer: Healthfirst Commercial |
$697.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,570.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$663.08
|
| Rate for Payer: Healthfirst QHP |
$697.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$488.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$697.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$593.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$488.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$697.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$523.49
|
| Rate for Payer: SOMOS Essential |
$523.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$697.98
|
|
|
PREVENTIVE DENTAL PROCEDURES
|
Facility
|
OP
|
$104.03
|
|
|
Service Code
|
EAPG 00377
|
| Min. Negotiated Rate |
$76.37 |
| Max. Negotiated Rate |
$104.03 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.37
|
| Rate for Payer: Healthfirst Commercial |
$104.03
|
|
|
PREVENTIVE OR SCREENING ENCOUNTER
|
Facility
|
OP
|
$222.15
|
|
|
Service Code
|
EAPG 00879
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$222.15 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.00
|
| Rate for Payer: Healthfirst Commercial |
$222.15
|
|
|
PR EVISCERATION OCULAR CONTENTS W/IMPLANT
|
Professional
|
Both
|
$3,110.84
|
|
|
Service Code
|
HCPCS 65093
|
| Min. Negotiated Rate |
$577.38 |
| Max. Negotiated Rate |
$1,855.87 |
| Rate for Payer: Cash Price |
$848.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$824.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$742.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$742.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$783.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$824.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$783.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$824.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$824.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$618.62
|
| Rate for Payer: Healthfirst Commercial |
$824.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,855.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$783.59
|
| Rate for Payer: Healthfirst QHP |
$824.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$577.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$824.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$701.11
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$577.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$824.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$618.62
|
| Rate for Payer: SOMOS Essential |
$618.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$824.83
|
|
|
PR EVISCERATION OCULAR CONTENTS W/O IMPLANT
|
Professional
|
Both
|
$3,131.21
|
|
|
Service Code
|
HCPCS 65091
|
| Min. Negotiated Rate |
$581.87 |
| Max. Negotiated Rate |
$1,870.29 |
| Rate for Payer: Cash Price |
$854.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$831.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$748.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$748.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$789.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$831.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$789.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$831.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$831.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$623.43
|
| Rate for Payer: Healthfirst Commercial |
$831.24
|
| Rate for Payer: Healthfirst Essential Plan |
$1,870.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$789.68
|
| Rate for Payer: Healthfirst QHP |
$831.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$581.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$831.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$706.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$581.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$831.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$623.43
|
| Rate for Payer: SOMOS Essential |
$623.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$831.24
|
|
|
PR EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSIS
|
Professional
|
Both
|
$77.70
|
|
|
Service Code
|
HCPCS 88363
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$46.30 |
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.44
|
| Rate for Payer: Healthfirst Commercial |
$20.58
|
| Rate for Payer: Healthfirst Essential Plan |
$46.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.55
|
| Rate for Payer: Healthfirst QHP |
$20.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$20.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$14.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$15.44
|
| Rate for Payer: SOMOS Essential |
$15.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.58
|
|
|
PR EXAM,SYNOVIAL FLUID CRYSTALS
|
Professional
|
Both
|
$69.20
|
|
|
Service Code
|
HCPCS 89060 26
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$43.18 |
| Rate for Payer: Cash Price |
$19.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Commercial |
$19.19
|
| Rate for Payer: Healthfirst Essential Plan |
$43.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.23
|
| Rate for Payer: Healthfirst QHP |
$19.19
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$13.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.19
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$16.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$13.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.68
|
| Rate for Payer: SOMOS Essential |
$7.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.19
|
|
|
PR EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOM
|
Professional
|
Both
|
$3,750.71
|
|
|
Service Code
|
HCPCS 44110
|
| Min. Negotiated Rate |
$702.31 |
| Max. Negotiated Rate |
$2,257.43 |
| Rate for Payer: Cash Price |
$1,012.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,003.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$902.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$902.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$953.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,003.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$953.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,003.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,003.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$752.48
|
| Rate for Payer: Healthfirst Commercial |
$1,003.30
|
| Rate for Payer: Healthfirst Essential Plan |
$2,257.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$953.13
|
| Rate for Payer: Healthfirst QHP |
$1,003.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$702.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,003.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$852.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$702.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,003.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$752.48
|
| Rate for Payer: SOMOS Essential |
$752.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,003.30
|
|
|
PR EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIE
|
Professional
|
Both
|
$4,374.72
|
|
|
Service Code
|
HCPCS 44111
|
| Min. Negotiated Rate |
$805.88 |
| Max. Negotiated Rate |
$2,590.34 |
| Rate for Payer: Cash Price |
$1,162.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,151.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,036.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,036.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,093.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,151.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,093.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,151.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,151.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$863.45
|
| Rate for Payer: Healthfirst Commercial |
$1,151.26
|
| Rate for Payer: Healthfirst Essential Plan |
$2,590.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,093.70
|
| Rate for Payer: Healthfirst QHP |
$1,151.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$805.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,151.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$978.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$805.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,151.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$863.45
|
| Rate for Payer: SOMOS Essential |
$863.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,151.26
|
|
|
PR EXC B1 CST/B9 TUM W/AGRFT REQ SEP INC
|
Professional
|
Both
|
$4,582.69
|
|
|
Service Code
|
HCPCS 27067
|
| Min. Negotiated Rate |
$861.64 |
| Max. Negotiated Rate |
$2,769.55 |
| Rate for Payer: Cash Price |
$1,236.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,230.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,107.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,107.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,169.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,230.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,169.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,230.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,230.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$923.18
|
| Rate for Payer: Healthfirst Commercial |
$1,230.91
|
| Rate for Payer: Healthfirst Essential Plan |
$2,769.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,169.36
|
| Rate for Payer: Healthfirst QHP |
$1,230.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$861.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,230.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,046.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$861.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,230.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$923.18
|
| Rate for Payer: SOMOS Essential |
$923.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,230.91
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$450.56
|
|
|
Service Code
|
HCPCS 11440
|
| Min. Negotiated Rate |
$87.30 |
| Max. Negotiated Rate |
$280.60 |
| Rate for Payer: Cash Price |
$125.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.53
|
| Rate for Payer: Healthfirst Commercial |
$124.71
|
| Rate for Payer: Healthfirst Essential Plan |
$280.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.47
|
| Rate for Payer: Healthfirst QHP |
$124.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.30
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.53
|
| Rate for Payer: SOMOS Essential |
$93.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.71
|
|
|
PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM
|
Professional
|
Both
|
$1,348.31
|
|
|
Service Code
|
HCPCS 11446
|
| Min. Negotiated Rate |
$258.64 |
| Max. Negotiated Rate |
$831.33 |
| Rate for Payer: Cash Price |
$369.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$369.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$332.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$332.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$351.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$369.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$351.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$369.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$369.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$277.11
|
| Rate for Payer: Healthfirst Commercial |
$369.48
|
| Rate for Payer: Healthfirst Essential Plan |
$831.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$351.01
|
| Rate for Payer: Healthfirst QHP |
$369.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$258.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$369.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$314.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$258.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$369.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$277.11
|
| Rate for Payer: SOMOS Essential |
$277.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$369.48
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$347.41
|
|
|
Service Code
|
HCPCS 11420
|
| Min. Negotiated Rate |
$66.98 |
| Max. Negotiated Rate |
$215.30 |
| Rate for Payer: Cash Price |
$95.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$95.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$90.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$95.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$90.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.77
|
| Rate for Payer: Healthfirst Commercial |
$95.69
|
| Rate for Payer: Healthfirst Essential Plan |
$215.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$90.91
|
| Rate for Payer: Healthfirst QHP |
$95.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$66.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$95.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$81.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$66.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$95.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$71.77
|
| Rate for Payer: SOMOS Essential |
$71.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$95.69
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$466.24
|
|
|
Service Code
|
HCPCS 11421
|
| Min. Negotiated Rate |
$88.02 |
| Max. Negotiated Rate |
$282.92 |
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$125.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$125.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.31
|
| Rate for Payer: Healthfirst Commercial |
$125.74
|
| Rate for Payer: Healthfirst Essential Plan |
$282.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.45
|
| Rate for Payer: Healthfirst QHP |
$125.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$125.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$125.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.31
|
| Rate for Payer: SOMOS Essential |
$94.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$125.74
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM
|
Professional
|
Both
|
$579.67
|
|
|
Service Code
|
HCPCS 11422
|
| Min. Negotiated Rate |
$111.01 |
| Max. Negotiated Rate |
$356.81 |
| Rate for Payer: Cash Price |
$158.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$158.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$142.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$150.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$158.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$150.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$158.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.94
|
| Rate for Payer: Healthfirst Commercial |
$158.58
|
| Rate for Payer: Healthfirst Essential Plan |
$356.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$150.65
|
| Rate for Payer: Healthfirst QHP |
$158.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$111.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$158.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$134.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$111.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$158.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$118.94
|
| Rate for Payer: SOMOS Essential |
$118.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.58
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$666.82
|
|
|
Service Code
|
HCPCS 11423
|
| Min. Negotiated Rate |
$128.91 |
| Max. Negotiated Rate |
$414.34 |
| Rate for Payer: Cash Price |
$183.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$165.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$165.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$174.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$174.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.11
|
| Rate for Payer: Healthfirst Commercial |
$184.15
|
| Rate for Payer: Healthfirst Essential Plan |
$414.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$174.94
|
| Rate for Payer: Healthfirst QHP |
$184.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$128.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$156.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$128.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.11
|
| Rate for Payer: SOMOS Essential |
$138.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.15
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$764.33
|
|
|
Service Code
|
HCPCS 11424
|
| Min. Negotiated Rate |
$148.95 |
| Max. Negotiated Rate |
$478.78 |
| Rate for Payer: Cash Price |
$212.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.59
|
| Rate for Payer: Healthfirst Commercial |
$212.79
|
| Rate for Payer: Healthfirst Essential Plan |
$478.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.15
|
| Rate for Payer: Healthfirst QHP |
$212.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$212.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$180.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.59
|
| Rate for Payer: SOMOS Essential |
$159.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.79
|
|
|
PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM
|
Professional
|
Both
|
$1,164.49
|
|
|
Service Code
|
HCPCS 11426
|
| Min. Negotiated Rate |
$219.79 |
| Max. Negotiated Rate |
$706.46 |
| Rate for Payer: Cash Price |
$313.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$313.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$282.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$282.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$298.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$313.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$298.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$313.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$313.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$235.49
|
| Rate for Payer: Healthfirst Commercial |
$313.98
|
| Rate for Payer: Healthfirst Essential Plan |
$706.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$298.28
|
| Rate for Payer: Healthfirst QHP |
$313.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$219.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$313.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$266.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$313.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$235.49
|
| Rate for Payer: SOMOS Essential |
$235.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$313.98
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<
|
Professional
|
Both
|
$359.73
|
|
|
Service Code
|
HCPCS 11400
|
| Min. Negotiated Rate |
$69.17 |
| Max. Negotiated Rate |
$222.34 |
| Rate for Payer: Cash Price |
$99.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$98.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$88.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$88.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$98.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$98.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$98.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.11
|
| Rate for Payer: Healthfirst Commercial |
$98.82
|
| Rate for Payer: Healthfirst Essential Plan |
$222.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$93.88
|
| Rate for Payer: Healthfirst QHP |
$98.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$69.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$98.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$84.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$69.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$98.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$74.11
|
| Rate for Payer: SOMOS Essential |
$74.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.82
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM
|
Professional
|
Both
|
$455.39
|
|
|
Service Code
|
HCPCS 11401
|
| Min. Negotiated Rate |
$85.88 |
| Max. Negotiated Rate |
$276.05 |
| Rate for Payer: Cash Price |
$123.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$122.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$116.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$122.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$116.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$92.02
|
| Rate for Payer: Healthfirst Commercial |
$122.69
|
| Rate for Payer: Healthfirst Essential Plan |
$276.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$116.56
|
| Rate for Payer: Healthfirst QHP |
$122.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$85.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$122.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$104.29
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$85.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$122.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$92.02
|
| Rate for Payer: SOMOS Essential |
$92.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$122.69
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM
|
Professional
|
Both
|
$493.78
|
|
|
Service Code
|
HCPCS 11402
|
| Min. Negotiated Rate |
$93.83 |
| Max. Negotiated Rate |
$301.61 |
| Rate for Payer: Cash Price |
$135.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$120.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$120.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.54
|
| Rate for Payer: Healthfirst Commercial |
$134.05
|
| Rate for Payer: Healthfirst Essential Plan |
$301.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.35
|
| Rate for Payer: Healthfirst QHP |
$134.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.54
|
| Rate for Payer: SOMOS Essential |
$100.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.05
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM
|
Professional
|
Both
|
$640.71
|
|
|
Service Code
|
HCPCS 11403
|
| Min. Negotiated Rate |
$123.05 |
| Max. Negotiated Rate |
$395.53 |
| Rate for Payer: Cash Price |
$175.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$158.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$158.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$167.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$167.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.84
|
| Rate for Payer: Healthfirst Commercial |
$175.79
|
| Rate for Payer: Healthfirst Essential Plan |
$395.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$167.00
|
| Rate for Payer: Healthfirst QHP |
$175.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$123.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$149.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$123.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.84
|
| Rate for Payer: SOMOS Essential |
$131.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.79
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM
|
Professional
|
Both
|
$712.22
|
|
|
Service Code
|
HCPCS 11404
|
| Min. Negotiated Rate |
$136.02 |
| Max. Negotiated Rate |
$437.20 |
| Rate for Payer: Cash Price |
$194.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$194.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$184.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$194.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$184.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.73
|
| Rate for Payer: Healthfirst Commercial |
$194.31
|
| Rate for Payer: Healthfirst Essential Plan |
$437.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$184.59
|
| Rate for Payer: Healthfirst QHP |
$194.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$194.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$165.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$194.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$145.73
|
| Rate for Payer: SOMOS Essential |
$145.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$194.31
|
|
|
PR EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM
|
Professional
|
Both
|
$1,081.61
|
|
|
Service Code
|
HCPCS 11406
|
| Min. Negotiated Rate |
$204.69 |
| Max. Negotiated Rate |
$657.92 |
| Rate for Payer: Cash Price |
$294.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$292.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$263.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$277.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$292.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$277.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$292.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$292.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$219.31
|
| Rate for Payer: Healthfirst Commercial |
$292.41
|
| Rate for Payer: Healthfirst Essential Plan |
$657.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$277.79
|
| Rate for Payer: Healthfirst QHP |
$292.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$204.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$292.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$248.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$204.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$292.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$219.31
|
| Rate for Payer: SOMOS Essential |
$219.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.41
|
|
|
PR EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$567.07
|
|
|
Service Code
|
HCPCS 11441
|
| Min. Negotiated Rate |
$107.99 |
| Max. Negotiated Rate |
$347.11 |
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$154.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$138.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$138.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$146.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$154.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$146.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$154.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.70
|
| Rate for Payer: Healthfirst Commercial |
$154.27
|
| Rate for Payer: Healthfirst Essential Plan |
$347.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$146.56
|
| Rate for Payer: Healthfirst QHP |
$154.27
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$107.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$154.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$131.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$107.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$154.27
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$115.70
|
| Rate for Payer: SOMOS Essential |
$115.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.27
|
|
