|
PR EXC ILEOANAL RSVR W/ILEOSTOMY
|
Professional
|
Both
|
$7,554.05
|
|
|
Service Code
|
HCPCS 45136
|
| Min. Negotiated Rate |
$1,416.47 |
| Max. Negotiated Rate |
$4,552.94 |
| Rate for Payer: Cash Price |
$2,044.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,023.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,821.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,821.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,922.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,023.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,922.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,023.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,023.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,517.65
|
| Rate for Payer: Healthfirst Commercial |
$2,023.53
|
| Rate for Payer: Healthfirst Essential Plan |
$4,552.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,922.35
|
| Rate for Payer: Healthfirst QHP |
$2,023.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,416.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,023.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,720.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,416.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,023.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,517.65
|
| Rate for Payer: SOMOS Essential |
$1,517.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,023.53
|
|
|
PR EXCIMER LASER TX PSORIASIS 250-500 SQ CM
|
Professional
|
Both
|
$288.51
|
|
|
Service Code
|
HCPCS 96921
|
| Min. Negotiated Rate |
$44.90 |
| Max. Negotiated Rate |
$144.31 |
| Rate for Payer: Amida Care Medicaid |
$45.45
|
| Rate for Payer: Cash Price |
$79.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$60.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$60.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.10
|
| Rate for Payer: Healthfirst Commercial |
$64.14
|
| Rate for Payer: Healthfirst Essential Plan |
$144.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.93
|
| Rate for Payer: Healthfirst QHP |
$64.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$64.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$54.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.10
|
| Rate for Payer: SOMOS Essential |
$48.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.14
|
|
|
PR EXCIMER LASER TX PSORIASIS >500 SQ CM
|
Professional
|
Both
|
$467.18
|
|
|
Service Code
|
HCPCS 96922
|
| Min. Negotiated Rate |
$63.63 |
| Max. Negotiated Rate |
$233.57 |
| Rate for Payer: Amida Care Medicaid |
$63.63
|
| Rate for Payer: Cash Price |
$127.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$103.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.86
|
| Rate for Payer: Healthfirst Commercial |
$103.81
|
| Rate for Payer: Healthfirst Essential Plan |
$233.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$98.62
|
| Rate for Payer: Healthfirst QHP |
$103.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$72.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$72.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$77.86
|
| Rate for Payer: SOMOS Essential |
$77.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.81
|
|
|
PR EXCIMER LASER TX PSORIASIS TOT AREA <250 SQ CM
|
Professional
|
Both
|
$252.74
|
|
|
Service Code
|
HCPCS 96920
|
| Min. Negotiated Rate |
$39.41 |
| Max. Negotiated Rate |
$126.67 |
| Rate for Payer: Amida Care Medicaid |
$44.44
|
| Rate for Payer: Cash Price |
$69.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$53.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$42.23
|
| Rate for Payer: Healthfirst Commercial |
$56.30
|
| Rate for Payer: Healthfirst Essential Plan |
$126.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$53.48
|
| Rate for Payer: Healthfirst QHP |
$56.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$39.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$56.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$47.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$39.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$42.23
|
| Rate for Payer: SOMOS Essential |
$42.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.30
|
|
|
PR EXC INTRACARDIAC TUMOR RESCJ CARDIOPULMONARY BYP
|
Professional
|
Both
|
$9,247.39
|
|
|
Service Code
|
HCPCS 33120
|
| Min. Negotiated Rate |
$1,705.31 |
| Max. Negotiated Rate |
$5,481.36 |
| Rate for Payer: Cash Price |
$2,459.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,436.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,192.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,192.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,314.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,436.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,314.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,436.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,436.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,827.12
|
| Rate for Payer: Healthfirst Commercial |
$2,436.16
|
| Rate for Payer: Healthfirst Essential Plan |
$5,481.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,314.35
|
| Rate for Payer: Healthfirst QHP |
$2,436.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,705.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,436.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,070.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,705.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,436.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,827.12
|
| Rate for Payer: SOMOS Essential |
$1,827.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,436.16
|
|
|
PR EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE
|
Professional
|
Both
|
$3,147.90
|
|
|
Service Code
|
HCPCS 15940
|
| Min. Negotiated Rate |
$590.75 |
| Max. Negotiated Rate |
$1,898.84 |
| Rate for Payer: Cash Price |
$846.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$843.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$759.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$759.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$801.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$843.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$801.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$843.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$843.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$632.95
|
| Rate for Payer: Healthfirst Commercial |
$843.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,898.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$801.73
|
| Rate for Payer: Healthfirst QHP |
$843.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$590.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$843.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$717.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$590.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$843.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$632.95
|
| Rate for Payer: SOMOS Essential |
$632.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$843.93
|
|
|
PR EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE
|
Professional
|
Both
|
$4,089.89
|
|
|
Service Code
|
HCPCS 15944
|
| Min. Negotiated Rate |
$769.52 |
| Max. Negotiated Rate |
$2,473.47 |
| Rate for Payer: Cash Price |
$1,103.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,099.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$989.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$989.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,044.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,099.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,044.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,099.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,099.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$824.49
|
| Rate for Payer: Healthfirst Commercial |
$1,099.32
|
| Rate for Payer: Healthfirst Essential Plan |
$2,473.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,044.35
|
| Rate for Payer: Healthfirst QHP |
$1,099.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$769.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,099.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$934.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$769.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,099.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$824.49
|
| Rate for Payer: SOMOS Essential |
$824.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,099.32
|
|
|
PR EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN
|
Professional
|
Both
|
$7,111.97
|
|
|
Service Code
|
HCPCS 15946
|
| Min. Negotiated Rate |
$1,317.82 |
| Max. Negotiated Rate |
$4,235.85 |
| Rate for Payer: Cash Price |
$1,905.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,882.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,694.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,694.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,788.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,882.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,788.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,882.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,882.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,411.95
|
| Rate for Payer: Healthfirst Commercial |
$1,882.60
|
| Rate for Payer: Healthfirst Essential Plan |
$4,235.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,788.47
|
| Rate for Payer: Healthfirst QHP |
$1,882.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,317.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,882.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,600.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,317.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,882.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,411.95
|
| Rate for Payer: SOMOS Essential |
$1,411.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,882.60
|
|
|
PR EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT
|
Professional
|
Both
|
$4,129.09
|
|
|
Service Code
|
HCPCS 15941
|
| Min. Negotiated Rate |
$780.05 |
| Max. Negotiated Rate |
$2,507.31 |
| Rate for Payer: Cash Price |
$1,099.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,114.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,002.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,002.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,058.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,114.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,058.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,114.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,114.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$835.77
|
| Rate for Payer: Healthfirst Commercial |
$1,114.36
|
| Rate for Payer: Healthfirst Essential Plan |
$2,507.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,058.64
|
| Rate for Payer: Healthfirst QHP |
$1,114.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$780.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,114.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$947.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$780.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,114.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$835.77
|
| Rate for Payer: SOMOS Essential |
$835.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,114.36
|
|
|
PR EXC ISCHIAL PR ULC W/SKN FLAP CLSR W/OSTECTOMY
|
Professional
|
Both
|
$4,460.65
|
|
|
Service Code
|
HCPCS 15945
|
| Min. Negotiated Rate |
$839.16 |
| Max. Negotiated Rate |
$2,697.30 |
| Rate for Payer: Cash Price |
$1,204.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,198.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,078.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,078.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,138.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,198.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,138.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,198.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,198.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$899.10
|
| Rate for Payer: Healthfirst Commercial |
$1,198.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,697.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,138.86
|
| Rate for Payer: Healthfirst QHP |
$1,198.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$839.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,198.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,018.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$839.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,198.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$899.10
|
| Rate for Payer: SOMOS Essential |
$899.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,198.80
|
|
|
PR EXCISION 1ST &/CERVICAL RIB
|
Professional
|
Both
|
$2,789.54
|
|
|
Service Code
|
HCPCS 21615
|
| Min. Negotiated Rate |
$519.33 |
| Max. Negotiated Rate |
$1,669.28 |
| Rate for Payer: Cash Price |
$747.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$741.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$667.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$667.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$704.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$741.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$704.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$741.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$741.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$556.42
|
| Rate for Payer: Healthfirst Commercial |
$741.90
|
| Rate for Payer: Healthfirst Essential Plan |
$1,669.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$704.80
|
| Rate for Payer: Healthfirst QHP |
$741.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$519.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$741.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$630.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$519.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$741.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$556.42
|
| Rate for Payer: SOMOS Essential |
$556.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$741.90
|
|
|
PR EXCISION 1ST &/CERVICAL RIB W/SYMPATHECTOMY
|
Professional
|
Both
|
$3,205.37
|
|
|
Service Code
|
HCPCS 21616
|
| Min. Negotiated Rate |
$593.17 |
| Max. Negotiated Rate |
$1,906.63 |
| Rate for Payer: Cash Price |
$855.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$847.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$762.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$762.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$805.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$847.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$805.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$847.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$847.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$635.54
|
| Rate for Payer: Healthfirst Commercial |
$847.39
|
| Rate for Payer: Healthfirst Essential Plan |
$1,906.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$805.02
|
| Rate for Payer: Healthfirst QHP |
$847.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$593.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$847.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$720.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$593.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$847.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$635.54
|
| Rate for Payer: SOMOS Essential |
$635.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$847.39
|
|
|
PR EXCISION AMPULLA VATER
|
Professional
|
Both
|
$5,665.35
|
|
|
Service Code
|
HCPCS 48148
|
| Min. Negotiated Rate |
$1,047.05 |
| Max. Negotiated Rate |
$3,365.51 |
| Rate for Payer: Cash Price |
$1,508.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,495.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,346.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,346.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,420.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,495.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,420.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,495.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,495.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,121.84
|
| Rate for Payer: Healthfirst Commercial |
$1,495.78
|
| Rate for Payer: Healthfirst Essential Plan |
$3,365.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,420.99
|
| Rate for Payer: Healthfirst QHP |
$1,495.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,047.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,495.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,271.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,047.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,495.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,121.84
|
| Rate for Payer: SOMOS Essential |
$1,121.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,495.78
|
|
|
PR EXCISION AURAL GLOMUS TUMOR EXTENDED
|
Professional
|
Both
|
$10,947.37
|
|
|
Service Code
|
HCPCS 69554
|
| Min. Negotiated Rate |
$2,038.06 |
| Max. Negotiated Rate |
$6,550.90 |
| Rate for Payer: Cash Price |
$2,949.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,911.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,620.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,620.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,765.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,911.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,765.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,911.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,911.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,183.63
|
| Rate for Payer: Healthfirst Commercial |
$2,911.51
|
| Rate for Payer: Healthfirst Essential Plan |
$6,550.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,765.93
|
| Rate for Payer: Healthfirst QHP |
$2,911.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,038.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,911.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,474.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,038.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,911.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,183.63
|
| Rate for Payer: SOMOS Essential |
$2,183.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,911.51
|
|
|
PR EXCISION AURAL GLOMUS TUMOR TRANSCANAL
|
Professional
|
Both
|
$4,627.49
|
|
|
Service Code
|
HCPCS 69550
|
| Min. Negotiated Rate |
$859.41 |
| Max. Negotiated Rate |
$2,762.39 |
| Rate for Payer: Cash Price |
$1,246.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,227.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,104.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,104.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,166.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,227.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,166.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,227.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,227.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$920.80
|
| Rate for Payer: Healthfirst Commercial |
$1,227.73
|
| Rate for Payer: Healthfirst Essential Plan |
$2,762.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,166.34
|
| Rate for Payer: Healthfirst QHP |
$1,227.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$859.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,227.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,043.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$859.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,227.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$920.80
|
| Rate for Payer: SOMOS Essential |
$920.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,227.73
|
|
|
PR EXCISION AURAL GLOMUS TUMOR TRANSMASTOID
|
Professional
|
Both
|
$6,886.74
|
|
|
Service Code
|
HCPCS 69552
|
| Min. Negotiated Rate |
$1,279.65 |
| Max. Negotiated Rate |
$4,113.16 |
| Rate for Payer: Cash Price |
$1,853.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,828.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,645.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,645.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,736.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,828.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,736.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,828.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,828.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,371.05
|
| Rate for Payer: Healthfirst Commercial |
$1,828.07
|
| Rate for Payer: Healthfirst Essential Plan |
$4,113.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,736.67
|
| Rate for Payer: Healthfirst QHP |
$1,828.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,279.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,828.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,553.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,279.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,828.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,371.05
|
| Rate for Payer: SOMOS Essential |
$1,371.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,828.07
|
|
|
PR EXCISION AURAL POLYP
|
Professional
|
Both
|
$567.91
|
|
|
Service Code
|
HCPCS 69540
|
| Min. Negotiated Rate |
$105.31 |
| Max. Negotiated Rate |
$338.51 |
| Rate for Payer: Cash Price |
$154.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.84
|
| Rate for Payer: Healthfirst Commercial |
$150.45
|
| Rate for Payer: Healthfirst Essential Plan |
$338.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.93
|
| Rate for Payer: Healthfirst QHP |
$150.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.84
|
| Rate for Payer: SOMOS Essential |
$112.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.45
|
|
|
PR EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT
|
Professional
|
Both
|
$1,533.91
|
|
|
Service Code
|
HCPCS 21040
|
| Min. Negotiated Rate |
$293.55 |
| Max. Negotiated Rate |
$943.56 |
| Rate for Payer: Cash Price |
$416.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$419.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$377.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$377.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$398.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$419.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$398.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$419.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$419.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$314.52
|
| Rate for Payer: Healthfirst Commercial |
$419.36
|
| Rate for Payer: Healthfirst Essential Plan |
$943.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$398.39
|
| Rate for Payer: Healthfirst QHP |
$419.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$293.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$419.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$356.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$293.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$419.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$314.52
|
| Rate for Payer: SOMOS Essential |
$314.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$419.36
|
|
|
PR EXCISION BONE CYST/BENIGN TUMOR DEEP
|
Professional
|
Both
|
$3,642.24
|
|
|
Service Code
|
HCPCS 27066
|
| Min. Negotiated Rate |
$683.76 |
| Max. Negotiated Rate |
$2,197.80 |
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$976.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$879.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$879.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$927.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$976.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$927.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$976.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$976.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$732.60
|
| Rate for Payer: Healthfirst Commercial |
$976.80
|
| Rate for Payer: Healthfirst Essential Plan |
$2,197.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$927.96
|
| Rate for Payer: Healthfirst QHP |
$976.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$683.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$976.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$830.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$683.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$976.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$732.60
|
| Rate for Payer: SOMOS Essential |
$732.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$976.80
|
|
|
PR EXCISION BONE CYST/BNIGN TUMOR SUPERFICIAL
|
Professional
|
Both
|
$2,348.54
|
|
|
Service Code
|
HCPCS 27065
|
| Min. Negotiated Rate |
$439.72 |
| Max. Negotiated Rate |
$1,413.38 |
| Rate for Payer: Cash Price |
$629.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$628.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$565.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$565.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$628.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$628.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$628.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$471.13
|
| Rate for Payer: Healthfirst Commercial |
$628.17
|
| Rate for Payer: Healthfirst Essential Plan |
$1,413.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$596.76
|
| Rate for Payer: Healthfirst QHP |
$628.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$439.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$628.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$533.94
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$439.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$628.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$471.13
|
| Rate for Payer: SOMOS Essential |
$471.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$628.17
|
|
|
PR EXCISION BONE MANDIBLE
|
Professional
|
Both
|
$2,778.62
|
|
|
Service Code
|
HCPCS 21025
|
| Min. Negotiated Rate |
$537.59 |
| Max. Negotiated Rate |
$1,727.98 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$767.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$691.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$729.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$767.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$729.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$767.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$767.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$575.99
|
| Rate for Payer: Healthfirst Commercial |
$767.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,727.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$729.59
|
| Rate for Payer: Healthfirst QHP |
$767.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$537.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$767.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$652.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$537.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$767.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$575.99
|
| Rate for Payer: SOMOS Essential |
$575.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$767.99
|
|
|
PR EXCISION CERVICAL STUMP ABDOMINAL APPROACH
|
Professional
|
Both
|
$3,458.32
|
|
|
Service Code
|
HCPCS 57540
|
| Min. Negotiated Rate |
$642.92 |
| Max. Negotiated Rate |
$2,066.53 |
| Rate for Payer: Cash Price |
$931.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$918.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$826.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$826.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$872.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$918.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$872.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$918.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$918.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$688.85
|
| Rate for Payer: Healthfirst Commercial |
$918.46
|
| Rate for Payer: Healthfirst Essential Plan |
$2,066.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$872.54
|
| Rate for Payer: Healthfirst QHP |
$918.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$642.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$918.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$780.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$642.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$918.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$688.85
|
| Rate for Payer: SOMOS Essential |
$688.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$918.46
|
|
|
PR EXCISION CERVICAL STUMP VAGINAL APPROACH
|
Professional
|
Both
|
$1,892.00
|
|
|
Service Code
|
HCPCS 57550
|
| Min. Negotiated Rate |
$351.02 |
| Max. Negotiated Rate |
$1,128.29 |
| Rate for Payer: Cash Price |
$512.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$501.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$451.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$451.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$476.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$501.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$476.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$501.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$501.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$376.10
|
| Rate for Payer: Healthfirst Commercial |
$501.46
|
| Rate for Payer: Healthfirst Essential Plan |
$1,128.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$476.39
|
| Rate for Payer: Healthfirst QHP |
$501.46
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$351.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$501.46
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$426.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$351.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$501.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$376.10
|
| Rate for Payer: SOMOS Essential |
$376.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$501.46
|
|
|
PR EXCISION CHALAZION MULTIPLE DIFFERENT LIDS
|
Professional
|
Both
|
$674.24
|
|
|
Service Code
|
HCPCS 67805
|
| Min. Negotiated Rate |
$127.58 |
| Max. Negotiated Rate |
$410.06 |
| Rate for Payer: Cash Price |
$184.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$164.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$164.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$173.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$173.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$182.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.69
|
| Rate for Payer: Healthfirst Commercial |
$182.25
|
| Rate for Payer: Healthfirst Essential Plan |
$410.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$173.14
|
| Rate for Payer: Healthfirst QHP |
$182.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$127.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$154.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$127.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$136.69
|
| Rate for Payer: SOMOS Essential |
$136.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.25
|
|
|
PR EXCISION CHALAZION MULTIPLE SAME LID
|
Professional
|
Both
|
$545.93
|
|
|
Service Code
|
HCPCS 67801
|
| Min. Negotiated Rate |
$103.25 |
| Max. Negotiated Rate |
$331.88 |
| Rate for Payer: Cash Price |
$148.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$147.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.62
|
| Rate for Payer: Healthfirst Commercial |
$147.50
|
| Rate for Payer: Healthfirst Essential Plan |
$331.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$140.12
|
| Rate for Payer: Healthfirst QHP |
$147.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$103.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$125.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$103.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$110.62
|
| Rate for Payer: SOMOS Essential |
$110.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.50
|
|
