|
PR EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH
|
Professional
|
Both
|
$1,597.82
|
|
|
Service Code
|
HCPCS 28080
|
| Min. Negotiated Rate |
$311.58 |
| Max. Negotiated Rate |
$1,001.50 |
| Rate for Payer: Cash Price |
$441.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$445.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$400.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$400.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$422.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$445.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$422.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$445.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$445.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$333.83
|
| Rate for Payer: Healthfirst Commercial |
$445.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,001.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$422.85
|
| Rate for Payer: Healthfirst QHP |
$445.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$311.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$445.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$378.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$311.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$445.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$333.83
|
| Rate for Payer: SOMOS Essential |
$333.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$445.11
|
|
|
PR EXCISION ISCHIAL BURSA
|
Professional
|
Both
|
$2,074.38
|
|
|
Service Code
|
HCPCS 27060
|
| Min. Negotiated Rate |
$393.62 |
| Max. Negotiated Rate |
$1,265.20 |
| Rate for Payer: Cash Price |
$563.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$562.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$506.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$506.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$534.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$562.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$534.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$562.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$562.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$421.73
|
| Rate for Payer: Healthfirst Commercial |
$562.31
|
| Rate for Payer: Healthfirst Essential Plan |
$1,265.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$534.19
|
| Rate for Payer: Healthfirst QHP |
$562.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$393.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$562.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$477.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$393.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$562.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$421.73
|
| Rate for Payer: SOMOS Essential |
$421.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$562.31
|
|
|
PR EXCISION LACRIMAL GLAND XCPT TUMOR PRTL
|
Professional
|
Both
|
$4,393.41
|
|
|
Service Code
|
HCPCS 68505
|
| Min. Negotiated Rate |
$828.41 |
| Max. Negotiated Rate |
$2,662.76 |
| Rate for Payer: Cash Price |
$1,205.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,183.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,065.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,065.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,124.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,183.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,124.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,183.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,183.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$887.59
|
| Rate for Payer: Healthfirst Commercial |
$1,183.45
|
| Rate for Payer: Healthfirst Essential Plan |
$2,662.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,124.28
|
| Rate for Payer: Healthfirst QHP |
$1,183.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$828.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,183.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,005.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$828.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,183.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$887.59
|
| Rate for Payer: SOMOS Essential |
$887.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,183.45
|
|
|
PR EXCISION LACRIMAL GLAND XCPT TUMOR TOTAL
|
Professional
|
Both
|
$4,413.36
|
|
|
Service Code
|
HCPCS 68500
|
| Min. Negotiated Rate |
$832.14 |
| Max. Negotiated Rate |
$2,674.73 |
| Rate for Payer: Cash Price |
$1,210.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,188.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,069.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,069.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,129.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,188.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,129.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,188.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,188.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$891.58
|
| Rate for Payer: Healthfirst Commercial |
$1,188.77
|
| Rate for Payer: Healthfirst Essential Plan |
$2,674.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,129.33
|
| Rate for Payer: Healthfirst QHP |
$1,188.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$832.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,188.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,010.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$832.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,188.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$891.58
|
| Rate for Payer: SOMOS Essential |
$891.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,188.77
|
|
|
PR EXCISION LACRIMAL SAC
|
Professional
|
Both
|
$3,079.02
|
|
|
Service Code
|
HCPCS 68520
|
| Min. Negotiated Rate |
$580.23 |
| Max. Negotiated Rate |
$1,865.03 |
| Rate for Payer: Cash Price |
$842.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$828.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$746.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$746.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$787.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$828.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$787.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$828.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$828.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$621.67
|
| Rate for Payer: Healthfirst Commercial |
$828.90
|
| Rate for Payer: Healthfirst Essential Plan |
$1,865.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$787.46
|
| Rate for Payer: Healthfirst QHP |
$828.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$580.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$828.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$704.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$580.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$828.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$621.67
|
| Rate for Payer: SOMOS Essential |
$621.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$828.90
|
|
|
PR EXCISION LACTIFEROUS DUCT FISTULA
|
Professional
|
Both
|
$1,445.82
|
|
|
Service Code
|
HCPCS 19112
|
| Min. Negotiated Rate |
$273.67 |
| Max. Negotiated Rate |
$879.64 |
| Rate for Payer: Cash Price |
$391.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$390.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$351.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$351.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$371.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$390.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$371.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$390.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$390.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$293.21
|
| Rate for Payer: Healthfirst Commercial |
$390.95
|
| Rate for Payer: Healthfirst Essential Plan |
$879.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$371.40
|
| Rate for Payer: Healthfirst QHP |
$390.95
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$273.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$390.95
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$332.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$273.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$390.95
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$293.21
|
| Rate for Payer: SOMOS Essential |
$293.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.95
|
|
|
PR EXCISION LESION CONJUNCTIVA <1 CM
|
Professional
|
Both
|
$611.24
|
|
|
Service Code
|
HCPCS 68110
|
| Min. Negotiated Rate |
$117.49 |
| Max. Negotiated Rate |
$377.64 |
| Rate for Payer: Cash Price |
$168.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$167.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$151.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$151.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$167.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$159.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$167.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$167.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.88
|
| Rate for Payer: Healthfirst Commercial |
$167.84
|
| Rate for Payer: Healthfirst Essential Plan |
$377.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$159.45
|
| Rate for Payer: Healthfirst QHP |
$167.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$117.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$167.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$142.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$117.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$167.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$125.88
|
| Rate for Payer: SOMOS Essential |
$125.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$167.84
|
|
|
PR EXCISION LESION CONJUNCTIVA > 1 CM
|
Professional
|
Both
|
$753.45
|
|
|
Service Code
|
HCPCS 68115
|
| Min. Negotiated Rate |
$143.34 |
| Max. Negotiated Rate |
$460.73 |
| Rate for Payer: Cash Price |
$207.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$204.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$184.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$184.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$204.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$204.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.58
|
| Rate for Payer: Healthfirst Commercial |
$204.77
|
| Rate for Payer: Healthfirst Essential Plan |
$460.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.53
|
| Rate for Payer: Healthfirst QHP |
$204.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$204.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$174.05
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$143.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$204.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.58
|
| Rate for Payer: SOMOS Essential |
$153.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$204.77
|
|
|
PR EXCISION LESION CONJUNCTIVA ADJACENT SCLERA
|
Professional
|
Both
|
$1,694.35
|
|
|
Service Code
|
HCPCS 68130
|
| Min. Negotiated Rate |
$325.05 |
| Max. Negotiated Rate |
$1,044.81 |
| Rate for Payer: Cash Price |
$470.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$464.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$417.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$417.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$441.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$464.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$441.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$464.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$464.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$348.27
|
| Rate for Payer: Healthfirst Commercial |
$464.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,044.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$441.14
|
| Rate for Payer: Healthfirst QHP |
$464.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$325.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$464.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$394.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$325.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$464.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$348.27
|
| Rate for Payer: SOMOS Essential |
$348.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$464.36
|
|
|
PR EXCISION LESION CORNEA XCP PTERYGIUM
|
Professional
|
Both
|
$2,488.12
|
|
|
Service Code
|
HCPCS 65400
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$1,526.78 |
| Rate for Payer: Cash Price |
$685.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$678.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$610.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$610.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$644.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$678.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$644.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$678.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$678.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$508.93
|
| Rate for Payer: Healthfirst Commercial |
$678.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,526.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$644.64
|
| Rate for Payer: Healthfirst QHP |
$678.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$475.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$678.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$576.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$475.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$678.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$508.93
|
| Rate for Payer: SOMOS Essential |
$508.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$678.57
|
|
|
PR EXCISION LESION FLOOR MOUTH
|
Professional
|
Both
|
$929.04
|
|
|
Service Code
|
HCPCS 41116
|
| Min. Negotiated Rate |
$176.55 |
| Max. Negotiated Rate |
$567.50 |
| Rate for Payer: Cash Price |
$253.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$252.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$227.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$227.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$252.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$239.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$252.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$252.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.16
|
| Rate for Payer: Healthfirst Commercial |
$252.22
|
| Rate for Payer: Healthfirst Essential Plan |
$567.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$239.61
|
| Rate for Payer: Healthfirst QHP |
$252.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$176.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$252.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$214.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$176.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$252.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$189.16
|
| Rate for Payer: SOMOS Essential |
$189.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$252.22
|
|
|
PR EXCISION LESION MENISCUS/CAPSULE KNEE
|
Professional
|
Both
|
$2,344.02
|
|
|
Service Code
|
HCPCS 27347
|
| Min. Negotiated Rate |
$444.05 |
| Max. Negotiated Rate |
$1,427.31 |
| Rate for Payer: Cash Price |
$635.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$634.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$570.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$570.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$602.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$634.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$602.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$634.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$634.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$475.77
|
| Rate for Payer: Healthfirst Commercial |
$634.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,427.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$602.64
|
| Rate for Payer: Healthfirst QHP |
$634.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$444.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$634.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$539.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$444.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$634.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$475.77
|
| Rate for Payer: SOMOS Essential |
$475.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$634.36
|
|
|
PR EXCISION LESION MESENTERY SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,855.46
|
|
|
Service Code
|
HCPCS 44820
|
| Min. Negotiated Rate |
$714.96 |
| Max. Negotiated Rate |
$2,298.08 |
| Rate for Payer: Cash Price |
$1,029.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,021.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$919.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$919.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$970.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,021.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$970.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,021.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,021.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$766.03
|
| Rate for Payer: Healthfirst Commercial |
$1,021.37
|
| Rate for Payer: Healthfirst Essential Plan |
$2,298.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$970.30
|
| Rate for Payer: Healthfirst QHP |
$1,021.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$714.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,021.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$868.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$714.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,021.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$766.03
|
| Rate for Payer: SOMOS Essential |
$766.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,021.37
|
|
|
PR EXCISION LESION PANCREAS
|
Professional
|
Both
|
$5,047.81
|
|
|
Service Code
|
HCPCS 48120
|
| Min. Negotiated Rate |
$932.56 |
| Max. Negotiated Rate |
$2,997.52 |
| Rate for Payer: Cash Price |
$1,342.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,332.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,199.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,199.01
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,265.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,332.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,265.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,332.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,332.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$999.17
|
| Rate for Payer: Healthfirst Commercial |
$1,332.23
|
| Rate for Payer: Healthfirst Essential Plan |
$2,997.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,265.62
|
| Rate for Payer: Healthfirst QHP |
$1,332.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$932.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,332.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,132.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$932.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,332.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$999.17
|
| Rate for Payer: SOMOS Essential |
$999.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,332.23
|
|
|
PR EXCISION LESION SCLERA
|
Professional
|
Both
|
$2,316.55
|
|
|
Service Code
|
HCPCS 66130
|
| Min. Negotiated Rate |
$441.60 |
| Max. Negotiated Rate |
$1,419.41 |
| Rate for Payer: Cash Price |
$638.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$630.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$567.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$567.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$599.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$599.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$630.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$630.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$473.14
|
| Rate for Payer: Healthfirst Commercial |
$630.85
|
| Rate for Payer: Healthfirst Essential Plan |
$1,419.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$599.31
|
| Rate for Payer: Healthfirst QHP |
$630.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$441.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$630.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$536.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$441.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$630.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$473.14
|
| Rate for Payer: SOMOS Essential |
$473.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$630.85
|
|
|
PR EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK
|
Professional
|
Both
|
$1,529.43
|
|
|
Service Code
|
HCPCS 27630
|
| Min. Negotiated Rate |
$296.03 |
| Max. Negotiated Rate |
$951.52 |
| Rate for Payer: Cash Price |
$422.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$422.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$380.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$380.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$401.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$422.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$401.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$422.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$422.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$317.18
|
| Rate for Payer: Healthfirst Commercial |
$422.90
|
| Rate for Payer: Healthfirst Essential Plan |
$951.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$401.75
|
| Rate for Payer: Healthfirst QHP |
$422.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$296.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$422.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$359.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$296.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$422.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$317.18
|
| Rate for Payer: SOMOS Essential |
$317.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$422.90
|
|
|
PR EXCISION LESION TENDON SHEATH FOREARM&/WRIST
|
Professional
|
Both
|
$1,540.67
|
|
|
Service Code
|
HCPCS 25110
|
| Min. Negotiated Rate |
$292.68 |
| Max. Negotiated Rate |
$940.75 |
| Rate for Payer: Cash Price |
$418.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$418.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$376.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$376.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$397.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$418.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$397.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$418.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$418.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$313.58
|
| Rate for Payer: Healthfirst Commercial |
$418.11
|
| Rate for Payer: Healthfirst Essential Plan |
$940.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$397.20
|
| Rate for Payer: Healthfirst QHP |
$418.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$292.68
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$418.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$355.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$292.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$418.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$313.58
|
| Rate for Payer: SOMOS Essential |
$313.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$418.11
|
|
|
PR EXCISION LESION TONGUE W/O CLOSURE
|
Professional
|
Both
|
$561.79
|
|
|
Service Code
|
HCPCS 41110
|
| Min. Negotiated Rate |
$105.13 |
| Max. Negotiated Rate |
$337.90 |
| Rate for Payer: Cash Price |
$152.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.64
|
| Rate for Payer: Healthfirst Commercial |
$150.18
|
| Rate for Payer: Healthfirst Essential Plan |
$337.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.67
|
| Rate for Payer: Healthfirst QHP |
$150.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.18
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.18
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.64
|
| Rate for Payer: SOMOS Essential |
$112.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.18
|
|
|
PR EXCISION LINGUAL FRENUM FRENECTOMY
|
Professional
|
Both
|
$631.86
|
|
|
Service Code
|
HCPCS 41115
|
| Min. Negotiated Rate |
$118.65 |
| Max. Negotiated Rate |
$381.38 |
| Rate for Payer: Cash Price |
$171.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$169.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$152.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$161.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$169.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$161.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.12
|
| Rate for Payer: Healthfirst Commercial |
$169.50
|
| Rate for Payer: Healthfirst Essential Plan |
$381.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.03
|
| Rate for Payer: Healthfirst QHP |
$169.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$118.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$169.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$144.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$118.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$169.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.12
|
| Rate for Payer: SOMOS Essential |
$127.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.50
|
|
|
PR EXCISION LOCAL LESION EPIDIDYMIS
|
Professional
|
Both
|
$1,570.73
|
|
|
Service Code
|
HCPCS 54830
|
| Min. Negotiated Rate |
$300.41 |
| Max. Negotiated Rate |
$965.61 |
| Rate for Payer: Cash Price |
$431.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$429.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$386.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$386.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$407.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$429.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$407.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$429.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$321.87
|
| Rate for Payer: Healthfirst Commercial |
$429.16
|
| Rate for Payer: Healthfirst Essential Plan |
$965.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$407.70
|
| Rate for Payer: Healthfirst QHP |
$429.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$300.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$429.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$364.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$300.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$429.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$321.87
|
| Rate for Payer: SOMOS Essential |
$321.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$429.16
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<
|
Professional
|
Both
|
$535.57
|
|
|
Service Code
|
HCPCS 11640
|
| Min. Negotiated Rate |
$102.34 |
| Max. Negotiated Rate |
$328.95 |
| Rate for Payer: Cash Price |
$147.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$146.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$131.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$131.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$138.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$146.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$138.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$146.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$109.65
|
| Rate for Payer: Healthfirst Commercial |
$146.20
|
| Rate for Payer: Healthfirst Essential Plan |
$328.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$138.89
|
| Rate for Payer: Healthfirst QHP |
$146.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$102.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$146.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$124.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$102.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$146.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$109.65
|
| Rate for Payer: SOMOS Essential |
$109.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$146.20
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM
|
Professional
|
Both
|
$659.05
|
|
|
Service Code
|
HCPCS 11641
|
| Min. Negotiated Rate |
$125.58 |
| Max. Negotiated Rate |
$403.65 |
| Rate for Payer: Cash Price |
$179.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$179.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$161.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$179.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.55
|
| Rate for Payer: Healthfirst Commercial |
$179.40
|
| Rate for Payer: Healthfirst Essential Plan |
$403.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$170.43
|
| Rate for Payer: Healthfirst QHP |
$179.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$125.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$179.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$152.49
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$125.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$179.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$134.55
|
| Rate for Payer: SOMOS Essential |
$134.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.40
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM
|
Professional
|
Both
|
$766.61
|
|
|
Service Code
|
HCPCS 11642
|
| Min. Negotiated Rate |
$146.20 |
| Max. Negotiated Rate |
$469.94 |
| Rate for Payer: Cash Price |
$210.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$208.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$187.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$187.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$198.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$208.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$198.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$156.65
|
| Rate for Payer: Healthfirst Commercial |
$208.86
|
| Rate for Payer: Healthfirst Essential Plan |
$469.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$198.42
|
| Rate for Payer: Healthfirst QHP |
$208.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$208.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$177.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$208.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$156.65
|
| Rate for Payer: SOMOS Essential |
$156.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.86
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM
|
Professional
|
Both
|
$962.75
|
|
|
Service Code
|
HCPCS 11643
|
| Min. Negotiated Rate |
$183.67 |
| Max. Negotiated Rate |
$590.36 |
| Rate for Payer: Cash Price |
$262.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$262.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$236.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$236.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$249.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$262.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$249.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$262.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$262.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$196.78
|
| Rate for Payer: Healthfirst Commercial |
$262.38
|
| Rate for Payer: Healthfirst Essential Plan |
$590.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.26
|
| Rate for Payer: Healthfirst QHP |
$262.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$183.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$262.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$223.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$183.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$262.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$196.78
|
| Rate for Payer: SOMOS Essential |
$196.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$262.38
|
|
|
PR EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM
|
Professional
|
Both
|
$1,199.38
|
|
|
Service Code
|
HCPCS 11644
|
| Min. Negotiated Rate |
$227.02 |
| Max. Negotiated Rate |
$729.70 |
| Rate for Payer: Cash Price |
$325.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$291.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$308.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$308.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$324.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$324.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$243.23
|
| Rate for Payer: Healthfirst Commercial |
$324.31
|
| Rate for Payer: Healthfirst Essential Plan |
$729.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.09
|
| Rate for Payer: Healthfirst QHP |
$324.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$227.02
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$324.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$275.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$227.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$243.23
|
| Rate for Payer: SOMOS Essential |
$243.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.31
|
|
