|
PR EXCISION CHALAZION SINGLE
|
Professional
|
Both
|
$420.88
|
|
|
Service Code
|
HCPCS 67800
|
| Min. Negotiated Rate |
$80.77 |
| Max. Negotiated Rate |
$259.61 |
| Rate for Payer: Cash Price |
$115.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$115.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.53
|
| Rate for Payer: Healthfirst Commercial |
$115.38
|
| Rate for Payer: Healthfirst Essential Plan |
$259.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.61
|
| Rate for Payer: Healthfirst QHP |
$115.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$115.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$98.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.53
|
| Rate for Payer: SOMOS Essential |
$86.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.38
|
|
|
PR EXCISION CHEST WALL TUMOR INCLUDING RIBS
|
Professional
|
Both
|
$5,127.01
|
|
|
Service Code
|
HCPCS 21601
|
| Min. Negotiated Rate |
$952.59 |
| Max. Negotiated Rate |
$3,061.89 |
| Rate for Payer: Cash Price |
$1,379.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,360.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,224.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,224.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,292.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,360.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,292.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,360.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,360.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,020.63
|
| Rate for Payer: Healthfirst Commercial |
$1,360.84
|
| Rate for Payer: Healthfirst Essential Plan |
$3,061.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,292.80
|
| Rate for Payer: Healthfirst QHP |
$1,360.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$952.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,360.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,156.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$952.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,360.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,020.63
|
| Rate for Payer: SOMOS Essential |
$1,020.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,360.84
|
|
|
PR EXCISION CHOLEDOCHAL CYST
|
Professional
|
Both
|
$6,021.09
|
|
|
Service Code
|
HCPCS 47715
|
| Min. Negotiated Rate |
$1,113.59 |
| Max. Negotiated Rate |
$3,579.39 |
| Rate for Payer: Cash Price |
$1,604.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,590.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,431.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,431.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,511.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,590.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,511.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,590.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,590.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,193.13
|
| Rate for Payer: Healthfirst Commercial |
$1,590.84
|
| Rate for Payer: Healthfirst Essential Plan |
$3,579.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,511.30
|
| Rate for Payer: Healthfirst QHP |
$1,590.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,113.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,590.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,352.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,113.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,590.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,193.13
|
| Rate for Payer: SOMOS Essential |
$1,193.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,590.84
|
|
|
PR EXCISION CH WAL TUM W/RIB W/MEDSTNL LYMPHADEC
|
Professional
|
Both
|
$7,517.44
|
|
|
Service Code
|
HCPCS 21603
|
| Min. Negotiated Rate |
$1,390.95 |
| Max. Negotiated Rate |
$4,470.91 |
| Rate for Payer: Cash Price |
$2,009.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,987.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,788.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,788.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,887.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,987.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,887.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,987.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,987.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,490.30
|
| Rate for Payer: Healthfirst Commercial |
$1,987.07
|
| Rate for Payer: Healthfirst Essential Plan |
$4,470.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,887.72
|
| Rate for Payer: Healthfirst QHP |
$1,987.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,390.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,987.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,689.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,390.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,987.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,490.30
|
| Rate for Payer: SOMOS Essential |
$1,490.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,987.07
|
|
|
PR EXCISION CH WAL TUM W/RIB W/O MEDSTNL LYMPHADEC
|
Professional
|
Both
|
$6,877.43
|
|
|
Service Code
|
HCPCS 21602
|
| Min. Negotiated Rate |
$1,280.66 |
| Max. Negotiated Rate |
$4,116.42 |
| Rate for Payer: Cash Price |
$1,830.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,829.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,646.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,646.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,738.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,829.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,738.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,829.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,829.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,372.14
|
| Rate for Payer: Healthfirst Commercial |
$1,829.52
|
| Rate for Payer: Healthfirst Essential Plan |
$4,116.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,738.04
|
| Rate for Payer: Healthfirst QHP |
$1,829.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,280.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,829.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,555.09
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,280.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,829.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,372.14
|
| Rate for Payer: SOMOS Essential |
$1,372.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,829.52
|
|
|
PR EXCISION COARCTATION AORTA W/WO PDA W/GRAFT
|
Professional
|
Both
|
$5,946.29
|
|
|
Service Code
|
HCPCS 33845
|
| Min. Negotiated Rate |
$1,100.43 |
| Max. Negotiated Rate |
$3,537.11 |
| Rate for Payer: Cash Price |
$1,585.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,572.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,414.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,414.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,493.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,572.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,493.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,572.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,572.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,179.04
|
| Rate for Payer: Healthfirst Commercial |
$1,572.05
|
| Rate for Payer: Healthfirst Essential Plan |
$3,537.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,493.45
|
| Rate for Payer: Healthfirst QHP |
$1,572.05
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,100.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,572.05
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,336.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,100.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,572.05
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,179.04
|
| Rate for Payer: SOMOS Essential |
$1,179.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,572.05
|
|
|
PR EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA
|
Professional
|
Both
|
$2,536.35
|
|
|
Service Code
|
HCPCS 27635
|
| Min. Negotiated Rate |
$477.79 |
| Max. Negotiated Rate |
$1,535.74 |
| Rate for Payer: Cash Price |
$689.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$682.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$614.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$614.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$648.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$682.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$648.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$682.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$682.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$511.91
|
| Rate for Payer: Healthfirst Commercial |
$682.55
|
| Rate for Payer: Healthfirst Essential Plan |
$1,535.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$648.42
|
| Rate for Payer: Healthfirst QHP |
$682.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$477.79
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$682.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$580.17
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$477.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$682.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$511.91
|
| Rate for Payer: SOMOS Essential |
$511.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$682.55
|
|
|
PR EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES
|
Professional
|
Both
|
$1,997.63
|
|
|
Service Code
|
HCPCS 25130
|
| Min. Negotiated Rate |
$381.42 |
| Max. Negotiated Rate |
$1,225.98 |
| Rate for Payer: Cash Price |
$544.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$544.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$490.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$490.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$517.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$544.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$517.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$544.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$544.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$408.66
|
| Rate for Payer: Healthfirst Commercial |
$544.88
|
| Rate for Payer: Healthfirst Essential Plan |
$1,225.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$517.64
|
| Rate for Payer: Healthfirst QHP |
$544.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$381.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$544.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$463.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$381.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$544.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$408.66
|
| Rate for Payer: SOMOS Essential |
$408.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$544.88
|
|
|
PR EXCISION/CURETTAGE CYST/TUMOR FEMUR
|
Professional
|
Both
|
$2,703.33
|
|
|
Service Code
|
HCPCS 27355
|
| Min. Negotiated Rate |
$512.22 |
| Max. Negotiated Rate |
$1,646.41 |
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$731.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$658.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$658.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$695.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$731.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$695.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$731.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$731.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$548.80
|
| Rate for Payer: Healthfirst Commercial |
$731.74
|
| Rate for Payer: Healthfirst Essential Plan |
$1,646.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$695.15
|
| Rate for Payer: Healthfirst QHP |
$731.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$512.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$731.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$621.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$512.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$731.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$548.80
|
| Rate for Payer: SOMOS Essential |
$548.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$731.74
|
|
|
PR EXCISION/CURETTAGE CYST/TUMOR FEMUR INT FIXATION
|
Professional
|
Both
|
$1,206.00
|
|
|
Service Code
|
HCPCS 27358
|
| Min. Negotiated Rate |
$223.96 |
| Max. Negotiated Rate |
$719.87 |
| Rate for Payer: Cash Price |
$322.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$319.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$287.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$287.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$303.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$319.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$303.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$319.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$319.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.96
|
| Rate for Payer: Healthfirst Commercial |
$319.94
|
| Rate for Payer: Healthfirst Essential Plan |
$719.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$303.94
|
| Rate for Payer: Healthfirst QHP |
$319.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$223.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$319.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$271.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$223.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$319.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.96
|
| Rate for Payer: SOMOS Essential |
$239.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$319.94
|
|
|
PR EXCISION/CURETTAGE CYST/TUMOR FEMUR W/ALLOGRAFT
|
Professional
|
Both
|
$3,286.89
|
|
|
Service Code
|
HCPCS 27356
|
| Min. Negotiated Rate |
$620.08 |
| Max. Negotiated Rate |
$1,993.12 |
| Rate for Payer: Cash Price |
$889.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$885.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$797.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$797.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$841.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$885.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$841.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$885.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$885.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$664.37
|
| Rate for Payer: Healthfirst Commercial |
$885.83
|
| Rate for Payer: Healthfirst Essential Plan |
$1,993.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$841.54
|
| Rate for Payer: Healthfirst QHP |
$885.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$620.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$885.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$752.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$620.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$885.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$664.37
|
| Rate for Payer: SOMOS Essential |
$664.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$885.83
|
|
|
PR EXCISION/CURETTAGE CYST/TUMOR FEMUR W/AUTOGRAFT
|
Professional
|
Both
|
$3,633.46
|
|
|
Service Code
|
HCPCS 27357
|
| Min. Negotiated Rate |
$681.11 |
| Max. Negotiated Rate |
$2,189.30 |
| Rate for Payer: Cash Price |
$980.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$973.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$875.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$875.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$924.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$973.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$924.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$973.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$973.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$729.76
|
| Rate for Payer: Healthfirst Commercial |
$973.02
|
| Rate for Payer: Healthfirst Essential Plan |
$2,189.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$924.37
|
| Rate for Payer: Healthfirst QHP |
$973.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$681.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$973.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$827.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$681.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$973.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$729.76
|
| Rate for Payer: SOMOS Essential |
$729.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$973.02
|
|
|
PR EXCISION/CURETTAGE CYST/TUMOR METACARPAL
|
Professional
|
Both
|
$2,003.93
|
|
|
Service Code
|
HCPCS 26200
|
| Min. Negotiated Rate |
$379.21 |
| Max. Negotiated Rate |
$1,218.89 |
| Rate for Payer: Cash Price |
$543.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$541.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$487.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$487.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$514.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$541.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$514.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$541.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$541.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$406.30
|
| Rate for Payer: Healthfirst Commercial |
$541.73
|
| Rate for Payer: Healthfirst Essential Plan |
$1,218.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$514.64
|
| Rate for Payer: Healthfirst QHP |
$541.73
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$379.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$541.73
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$460.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$379.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$541.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$406.30
|
| Rate for Payer: SOMOS Essential |
$406.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$541.73
|
|
|
PR EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER
|
Professional
|
Both
|
$1,985.41
|
|
|
Service Code
|
HCPCS 26210
|
| Min. Negotiated Rate |
$377.89 |
| Max. Negotiated Rate |
$1,214.66 |
| Rate for Payer: Cash Price |
$541.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$539.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$485.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$485.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$512.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$539.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$512.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$539.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$539.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$404.89
|
| Rate for Payer: Healthfirst Commercial |
$539.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,214.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$512.86
|
| Rate for Payer: Healthfirst QHP |
$539.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$377.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$539.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$458.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$377.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$539.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$404.89
|
| Rate for Payer: SOMOS Essential |
$404.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$539.85
|
|
|
PR EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA
|
Professional
|
Both
|
$2,226.56
|
|
|
Service Code
|
HCPCS 25120
|
| Min. Negotiated Rate |
$422.56 |
| Max. Negotiated Rate |
$1,358.21 |
| Rate for Payer: Cash Price |
$605.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$603.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$543.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$543.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$573.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$603.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$573.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$603.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$603.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$452.74
|
| Rate for Payer: Healthfirst Commercial |
$603.65
|
| Rate for Payer: Healthfirst Essential Plan |
$1,358.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$573.47
|
| Rate for Payer: Healthfirst QHP |
$603.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$422.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$603.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$513.10
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$422.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$603.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$452.74
|
| Rate for Payer: SOMOS Essential |
$452.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$603.65
|
|
|
PR EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS
|
Professional
|
Both
|
$1,805.13
|
|
|
Service Code
|
HCPCS 28100
|
| Min. Negotiated Rate |
$343.99 |
| Max. Negotiated Rate |
$1,105.67 |
| Rate for Payer: Cash Price |
$491.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$491.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$442.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$442.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$466.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$491.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$466.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$491.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$491.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$368.56
|
| Rate for Payer: Healthfirst Commercial |
$491.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,105.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$466.84
|
| Rate for Payer: Healthfirst QHP |
$491.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$343.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$491.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$417.70
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$343.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$491.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$368.56
|
| Rate for Payer: SOMOS Essential |
$368.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$491.41
|
|
|
PR EXCISION/CURTG BONE CYST/BENIGN TUMOR HUMERUS
|
Professional
|
Both
|
$2,631.44
|
|
|
Service Code
|
HCPCS 24110
|
| Min. Negotiated Rate |
$497.82 |
| Max. Negotiated Rate |
$1,600.13 |
| Rate for Payer: Cash Price |
$712.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$711.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$640.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$640.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$675.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$711.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$675.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$711.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$711.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$533.38
|
| Rate for Payer: Healthfirst Commercial |
$711.17
|
| Rate for Payer: Healthfirst Essential Plan |
$1,600.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$675.61
|
| Rate for Payer: Healthfirst QHP |
$711.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$497.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$711.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$604.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$497.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$711.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$533.38
|
| Rate for Payer: SOMOS Essential |
$533.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$711.17
|
|
|
PR EXCISION DERMOID CYST NOSE SIMPLE SUBCUTANEOUS
|
Professional
|
Both
|
$1,321.88
|
|
|
Service Code
|
HCPCS 30124
|
| Min. Negotiated Rate |
$248.19 |
| Max. Negotiated Rate |
$797.76 |
| Rate for Payer: Cash Price |
$360.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$354.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$319.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$319.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$336.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$354.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$336.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$354.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$354.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$265.92
|
| Rate for Payer: Healthfirst Commercial |
$354.56
|
| Rate for Payer: Healthfirst Essential Plan |
$797.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$336.83
|
| Rate for Payer: Healthfirst QHP |
$354.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$248.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$354.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$301.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$248.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$354.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$265.92
|
| Rate for Payer: SOMOS Essential |
$265.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$354.56
|
|
|
PR EXCISION/DESTRUCTION INTRANASAL LESION INT APPR
|
Professional
|
Both
|
$1,444.10
|
|
|
Service Code
|
HCPCS 30117
|
| Min. Negotiated Rate |
$332.90 |
| Max. Negotiated Rate |
$1,070.03 |
| Rate for Payer: Cash Price |
$486.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$475.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$428.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$428.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$451.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$475.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$451.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$475.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$475.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$356.68
|
| Rate for Payer: Healthfirst Commercial |
$475.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,070.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$451.79
|
| Rate for Payer: Healthfirst QHP |
$475.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$332.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$475.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$404.23
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$332.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$475.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$356.68
|
| Rate for Payer: SOMOS Essential |
$356.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$475.57
|
|
|
PR EXCISION/DESTRUCTION INTRANASAL LESION XTRNL
|
Professional
|
Both
|
$3,451.28
|
|
|
Service Code
|
HCPCS 30118
|
| Min. Negotiated Rate |
$570.80 |
| Max. Negotiated Rate |
$1,834.72 |
| Rate for Payer: Cash Price |
$834.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$815.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$733.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$733.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$774.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$815.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$774.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$815.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$611.57
|
| Rate for Payer: Healthfirst Commercial |
$815.43
|
| Rate for Payer: Healthfirst Essential Plan |
$1,834.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$774.66
|
| Rate for Payer: Healthfirst QHP |
$815.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$570.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$815.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$693.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$570.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$815.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$611.57
|
| Rate for Payer: SOMOS Essential |
$611.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$815.43
|
|
|
PR EXCISION/DESTRUCTION LESION PHARYNX ANY METHOD
|
Professional
|
Both
|
$719.43
|
|
|
Service Code
|
HCPCS 42808
|
| Min. Negotiated Rate |
$136.21 |
| Max. Negotiated Rate |
$437.81 |
| Rate for Payer: Cash Price |
$195.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$194.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$175.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$175.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$184.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$194.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$184.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.94
|
| Rate for Payer: Healthfirst Commercial |
$194.58
|
| Rate for Payer: Healthfirst Essential Plan |
$437.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$184.85
|
| Rate for Payer: Healthfirst QHP |
$194.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$136.21
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$194.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$165.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$136.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$194.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$145.94
|
| Rate for Payer: SOMOS Essential |
$145.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$194.58
|
|
|
PR EXCISION/DESTRUCTION OPEN ABDOMINAL TUMOR 5 CM/<
|
Professional
|
Both
|
$5,319.76
|
|
|
Service Code
|
HCPCS 49203
|
| Rate for Payer: Cash Price |
$1,423.27
|
|
|
PR EXCISION DISTAL ULNA PARTIAL/COMPLETE
|
Professional
|
Both
|
$1,906.38
|
|
|
Service Code
|
HCPCS 25240
|
| Min. Negotiated Rate |
$363.15 |
| Max. Negotiated Rate |
$1,167.26 |
| Rate for Payer: Cash Price |
$520.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$518.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$466.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$466.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$492.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$518.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$492.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$518.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$518.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$389.08
|
| Rate for Payer: Healthfirst Commercial |
$518.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,167.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$492.84
|
| Rate for Payer: Healthfirst QHP |
$518.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$363.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$518.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$440.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$363.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$518.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$389.08
|
| Rate for Payer: SOMOS Essential |
$389.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$518.78
|
|
|
PR EXCISION EPIPHYSEAL BAR
|
Professional
|
Both
|
$4,431.18
|
|
|
Service Code
|
HCPCS 20150
|
| Min. Negotiated Rate |
$833.17 |
| Max. Negotiated Rate |
$2,678.06 |
| Rate for Payer: Cash Price |
$1,195.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,190.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,071.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,071.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,130.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,190.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,130.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,190.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$892.69
|
| Rate for Payer: Healthfirst Commercial |
$1,190.25
|
| Rate for Payer: Healthfirst Essential Plan |
$2,678.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,130.74
|
| Rate for Payer: Healthfirst QHP |
$1,190.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$833.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,190.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,011.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$833.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,190.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$892.69
|
| Rate for Payer: SOMOS Essential |
$892.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,190.25
|
|
|
PR EXCISION EXCESSIVE SKIN & SUBQ TISSUE ARM
|
Professional
|
Both
|
$3,484.36
|
|
|
Service Code
|
HCPCS 15836
|
| Min. Negotiated Rate |
$657.59 |
| Max. Negotiated Rate |
$2,113.67 |
| Rate for Payer: Cash Price |
$941.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$939.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$845.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$845.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$892.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$939.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$892.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$939.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$939.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$704.56
|
| Rate for Payer: Healthfirst Commercial |
$939.41
|
| Rate for Payer: Healthfirst Essential Plan |
$2,113.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$892.44
|
| Rate for Payer: Healthfirst QHP |
$939.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$657.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$939.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$798.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$657.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$939.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$704.56
|
| Rate for Payer: SOMOS Essential |
$704.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$939.41
|
|
