|
PR EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM
|
Professional
|
Both
|
$1,672.02
|
|
|
Service Code
|
HCPCS 11646
|
| Min. Negotiated Rate |
$313.89 |
| Max. Negotiated Rate |
$1,008.92 |
| Rate for Payer: Cash Price |
$451.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$448.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$403.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$403.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$425.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$448.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$425.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$448.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$448.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$336.31
|
| Rate for Payer: Healthfirst Commercial |
$448.41
|
| Rate for Payer: Healthfirst Essential Plan |
$1,008.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$425.99
|
| Rate for Payer: Healthfirst QHP |
$448.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$313.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$448.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$381.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$313.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$448.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$336.31
|
| Rate for Payer: SOMOS Essential |
$336.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$448.41
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$524.34
|
|
|
Service Code
|
HCPCS 11620
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Cash Price |
$143.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$135.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$135.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.72
|
| Rate for Payer: Healthfirst Commercial |
$142.29
|
| Rate for Payer: Healthfirst Essential Plan |
$320.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$135.18
|
| Rate for Payer: Healthfirst QHP |
$142.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$99.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$142.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$120.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$99.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.72
|
| Rate for Payer: SOMOS Essential |
$106.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.29
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM
|
Professional
|
Both
|
$633.54
|
|
|
Service Code
|
HCPCS 11621
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$388.28 |
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$172.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$155.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$163.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$172.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$163.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$129.43
|
| Rate for Payer: Healthfirst Commercial |
$172.57
|
| Rate for Payer: Healthfirst Essential Plan |
$388.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.94
|
| Rate for Payer: Healthfirst QHP |
$172.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$120.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$172.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$146.68
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$120.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$172.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$129.43
|
| Rate for Payer: SOMOS Essential |
$129.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$172.57
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM
|
Professional
|
Both
|
$712.11
|
|
|
Service Code
|
HCPCS 11622
|
| Min. Negotiated Rate |
$135.72 |
| Max. Negotiated Rate |
$436.23 |
| Rate for Payer: Cash Price |
$195.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$193.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$184.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$193.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$184.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$193.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$193.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.41
|
| Rate for Payer: Healthfirst Commercial |
$193.88
|
| Rate for Payer: Healthfirst Essential Plan |
$436.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$184.19
|
| Rate for Payer: Healthfirst QHP |
$193.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$135.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$193.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$164.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$135.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$193.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$145.41
|
| Rate for Payer: SOMOS Essential |
$145.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$193.88
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM
|
Professional
|
Both
|
$888.55
|
|
|
Service Code
|
HCPCS 11623
|
| Min. Negotiated Rate |
$168.11 |
| Max. Negotiated Rate |
$540.36 |
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$240.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$216.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$216.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$228.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$240.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$228.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$240.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$240.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.12
|
| Rate for Payer: Healthfirst Commercial |
$240.16
|
| Rate for Payer: Healthfirst Essential Plan |
$540.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$228.15
|
| Rate for Payer: Healthfirst QHP |
$240.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$168.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$240.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$204.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$168.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$240.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$180.12
|
| Rate for Payer: SOMOS Essential |
$180.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$240.16
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM
|
Professional
|
Both
|
$1,014.13
|
|
|
Service Code
|
HCPCS 11624
|
| Min. Negotiated Rate |
$191.41 |
| Max. Negotiated Rate |
$615.26 |
| Rate for Payer: Cash Price |
$275.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$273.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$246.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$246.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$259.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$259.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.09
|
| Rate for Payer: Healthfirst Commercial |
$273.45
|
| Rate for Payer: Healthfirst Essential Plan |
$615.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$259.78
|
| Rate for Payer: Healthfirst QHP |
$273.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$191.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$273.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$232.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$191.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$273.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$205.09
|
| Rate for Payer: SOMOS Essential |
$205.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$273.45
|
|
|
PR EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM
|
Professional
|
Both
|
$1,256.99
|
|
|
Service Code
|
HCPCS 11626
|
| Min. Negotiated Rate |
$236.05 |
| Max. Negotiated Rate |
$758.75 |
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$337.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$303.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$303.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$320.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$337.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$320.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$337.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$252.91
|
| Rate for Payer: Healthfirst Commercial |
$337.22
|
| Rate for Payer: Healthfirst Essential Plan |
$758.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$320.36
|
| Rate for Payer: Healthfirst QHP |
$337.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$236.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$337.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$286.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$236.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$337.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$252.91
|
| Rate for Payer: SOMOS Essential |
$252.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$337.22
|
|
|
PR EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM
|
Professional
|
Both
|
$1,364.72
|
|
|
Service Code
|
HCPCS 11606
|
| Min. Negotiated Rate |
$256.47 |
| Max. Negotiated Rate |
$824.36 |
| Rate for Payer: Cash Price |
$369.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$366.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$329.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$329.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$348.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$366.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$348.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$366.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$366.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$274.79
|
| Rate for Payer: Healthfirst Commercial |
$366.38
|
| Rate for Payer: Healthfirst Essential Plan |
$824.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$348.06
|
| Rate for Payer: Healthfirst QHP |
$366.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$256.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$366.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$311.42
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$256.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$366.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$274.79
|
| Rate for Payer: SOMOS Essential |
$274.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$366.38
|
|
|
PR EXCISION MALIGNANT TUMOR MANDIBLE
|
Professional
|
Both
|
$3,699.33
|
|
|
Service Code
|
HCPCS 21044
|
| Min. Negotiated Rate |
$698.47 |
| Max. Negotiated Rate |
$2,245.09 |
| Rate for Payer: Cash Price |
$1,005.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$997.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$898.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$947.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$997.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$947.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$997.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$997.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$748.37
|
| Rate for Payer: Healthfirst Commercial |
$997.82
|
| Rate for Payer: Healthfirst Essential Plan |
$2,245.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$947.93
|
| Rate for Payer: Healthfirst QHP |
$997.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$698.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$997.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$848.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$698.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$997.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$748.37
|
| Rate for Payer: SOMOS Essential |
$748.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$997.82
|
|
|
PR EXCISION MALIGNANT TUMOR MANDIBLE RADICAL
|
Professional
|
Both
|
$5,143.95
|
|
|
Service Code
|
HCPCS 21045
|
| Min. Negotiated Rate |
$967.46 |
| Max. Negotiated Rate |
$3,109.68 |
| Rate for Payer: Cash Price |
$1,394.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,382.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,243.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,243.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,312.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,382.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,312.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,382.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,382.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,036.56
|
| Rate for Payer: Healthfirst Commercial |
$1,382.08
|
| Rate for Payer: Healthfirst Essential Plan |
$3,109.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,312.98
|
| Rate for Payer: Healthfirst QHP |
$1,382.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$967.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,382.08
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,174.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$967.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,382.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,036.56
|
| Rate for Payer: SOMOS Essential |
$1,036.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,382.08
|
|
|
PR EXCISION MALIGNANT TUMOR MAXILLA/ZYGOMA
|
Professional
|
Both
|
$4,831.61
|
|
|
Service Code
|
HCPCS 21034
|
| Min. Negotiated Rate |
$907.37 |
| Max. Negotiated Rate |
$2,916.54 |
| Rate for Payer: Cash Price |
$1,307.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,296.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,166.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,166.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,231.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,296.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,231.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,296.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,296.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$972.18
|
| Rate for Payer: Healthfirst Commercial |
$1,296.24
|
| Rate for Payer: Healthfirst Essential Plan |
$2,916.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,231.43
|
| Rate for Payer: Healthfirst QHP |
$1,296.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$907.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,296.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,101.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$907.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,296.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$972.18
|
| Rate for Payer: SOMOS Essential |
$972.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,296.24
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<
|
Professional
|
Both
|
$521.68
|
|
|
Service Code
|
HCPCS 11600
|
| Min. Negotiated Rate |
$98.66 |
| Max. Negotiated Rate |
$317.12 |
| Rate for Payer: Cash Price |
$142.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$140.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$126.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$126.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$133.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$140.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$133.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$140.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$140.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.70
|
| Rate for Payer: Healthfirst Commercial |
$140.94
|
| Rate for Payer: Healthfirst Essential Plan |
$317.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.89
|
| Rate for Payer: Healthfirst QHP |
$140.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$98.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$140.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$119.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$98.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$140.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$105.70
|
| Rate for Payer: SOMOS Essential |
$105.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$140.94
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$628.11
|
|
|
Service Code
|
HCPCS 11601
|
| Min. Negotiated Rate |
$119.43 |
| Max. Negotiated Rate |
$383.87 |
| Rate for Payer: Cash Price |
$171.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$170.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$170.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$170.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.96
|
| Rate for Payer: Healthfirst Commercial |
$170.61
|
| Rate for Payer: Healthfirst Essential Plan |
$383.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.08
|
| Rate for Payer: Healthfirst QHP |
$170.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$119.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$170.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$145.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$119.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$170.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$127.96
|
| Rate for Payer: SOMOS Essential |
$127.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$170.61
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM
|
Professional
|
Both
|
$679.04
|
|
|
Service Code
|
HCPCS 11602
|
| Min. Negotiated Rate |
$129.41 |
| Max. Negotiated Rate |
$415.96 |
| Rate for Payer: Cash Price |
$185.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$166.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$166.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$175.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$175.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.65
|
| Rate for Payer: Healthfirst Commercial |
$184.87
|
| Rate for Payer: Healthfirst Essential Plan |
$415.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$175.63
|
| Rate for Payer: Healthfirst QHP |
$184.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$129.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$184.87
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$157.14
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$129.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$138.65
|
| Rate for Payer: SOMOS Essential |
$138.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.87
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM
|
Professional
|
Both
|
$818.41
|
|
|
Service Code
|
HCPCS 11603
|
| Min. Negotiated Rate |
$154.99 |
| Max. Negotiated Rate |
$498.17 |
| Rate for Payer: Cash Price |
$222.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$221.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$199.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$199.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$210.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$221.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$210.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$221.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$221.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.06
|
| Rate for Payer: Healthfirst Commercial |
$221.41
|
| Rate for Payer: Healthfirst Essential Plan |
$498.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.34
|
| Rate for Payer: Healthfirst QHP |
$221.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$154.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$221.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$188.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$154.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$221.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$166.06
|
| Rate for Payer: SOMOS Essential |
$166.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$221.41
|
|
|
PR EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM
|
Professional
|
Both
|
$904.40
|
|
|
Service Code
|
HCPCS 11604
|
| Min. Negotiated Rate |
$171.40 |
| Max. Negotiated Rate |
$550.93 |
| Rate for Payer: Cash Price |
$245.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$244.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$220.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$220.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$232.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$244.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$232.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$244.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$244.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$183.65
|
| Rate for Payer: Healthfirst Commercial |
$244.86
|
| Rate for Payer: Healthfirst Essential Plan |
$550.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$232.62
|
| Rate for Payer: Healthfirst QHP |
$244.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$171.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$244.86
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$208.13
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$171.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$244.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$183.65
|
| Rate for Payer: SOMOS Essential |
$183.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$244.86
|
|
|
PR EXCISION MAXILLARY TORUS PALATINUS
|
Professional
|
Both
|
$1,097.85
|
|
|
Service Code
|
HCPCS 21032
|
| Min. Negotiated Rate |
$212.41 |
| Max. Negotiated Rate |
$682.74 |
| Rate for Payer: Cash Price |
$301.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$303.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$273.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$273.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$303.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$303.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$303.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$227.58
|
| Rate for Payer: Healthfirst Commercial |
$303.44
|
| Rate for Payer: Healthfirst Essential Plan |
$682.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$288.27
|
| Rate for Payer: Healthfirst QHP |
$303.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$212.41
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$303.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$257.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$212.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$303.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$227.58
|
| Rate for Payer: SOMOS Essential |
$227.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$303.44
|
|
|
PR EXCISION MULLERIAN DUCT CYST
|
Professional
|
Both
|
$1,462.72
|
|
|
Service Code
|
HCPCS 55680
|
| Min. Negotiated Rate |
$280.16 |
| Max. Negotiated Rate |
$900.52 |
| Rate for Payer: Cash Price |
$402.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$400.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$360.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$360.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$380.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$400.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$380.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$300.17
|
| Rate for Payer: Healthfirst Commercial |
$400.23
|
| Rate for Payer: Healthfirst Essential Plan |
$900.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$380.22
|
| Rate for Payer: Healthfirst QHP |
$400.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$280.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$400.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$340.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$280.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$400.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$300.17
|
| Rate for Payer: SOMOS Essential |
$300.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$400.23
|
|
|
PR EXCISION MULTIPLE EXTERNAL PAPILLAE/TAGS ANUS
|
Professional
|
Both
|
$753.31
|
|
|
Service Code
|
HCPCS 46230
|
| Min. Negotiated Rate |
$143.61 |
| Max. Negotiated Rate |
$461.61 |
| Rate for Payer: Cash Price |
$205.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$205.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$184.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$184.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$194.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$205.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$194.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$205.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$205.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$153.87
|
| Rate for Payer: Healthfirst Commercial |
$205.16
|
| Rate for Payer: Healthfirst Essential Plan |
$461.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$194.90
|
| Rate for Payer: Healthfirst QHP |
$205.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$143.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$205.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$174.39
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$143.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$205.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$153.87
|
| Rate for Payer: SOMOS Essential |
$153.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$205.16
|
|
|
PR EXCISION NAIL MATRIX PERMANENT REMOVAL
|
Professional
|
Both
|
$416.15
|
|
|
Service Code
|
HCPCS 11750
|
| Min. Negotiated Rate |
$80.67 |
| Max. Negotiated Rate |
$259.31 |
| Rate for Payer: Cash Price |
$116.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$115.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$103.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$103.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$109.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$115.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$109.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.44
|
| Rate for Payer: Healthfirst Commercial |
$115.25
|
| Rate for Payer: Healthfirst Essential Plan |
$259.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$109.49
|
| Rate for Payer: Healthfirst QHP |
$115.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$80.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$115.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$97.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$80.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$115.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$86.44
|
| Rate for Payer: SOMOS Essential |
$86.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.25
|
|
|
PR EXCISION NASAL POLYP EXTENSIVE
|
Professional
|
Both
|
$2,043.51
|
|
|
Service Code
|
HCPCS 30115
|
| Min. Negotiated Rate |
$377.24 |
| Max. Negotiated Rate |
$1,212.55 |
| Rate for Payer: Cash Price |
$549.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$538.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$485.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$485.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$511.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$538.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$511.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$538.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$538.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$404.18
|
| Rate for Payer: Healthfirst Commercial |
$538.91
|
| Rate for Payer: Healthfirst Essential Plan |
$1,212.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$511.96
|
| Rate for Payer: Healthfirst QHP |
$538.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$377.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$538.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$458.07
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$377.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$538.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$404.18
|
| Rate for Payer: SOMOS Essential |
$404.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$538.91
|
|
|
PR EXCISION NASAL POLYP SIMPLE
|
Professional
|
Both
|
$570.92
|
|
|
Service Code
|
HCPCS 30110
|
| Min. Negotiated Rate |
$108.77 |
| Max. Negotiated Rate |
$349.63 |
| Rate for Payer: Cash Price |
$156.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$155.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.54
|
| Rate for Payer: Healthfirst Commercial |
$155.39
|
| Rate for Payer: Healthfirst Essential Plan |
$349.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.62
|
| Rate for Payer: Healthfirst QHP |
$155.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.54
|
| Rate for Payer: SOMOS Essential |
$116.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.39
|
|
|
PR EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT
|
Professional
|
Both
|
$796.08
|
|
|
Service Code
|
HCPCS 64778
|
| Min. Negotiated Rate |
$146.82 |
| Max. Negotiated Rate |
$471.92 |
| Rate for Payer: Cash Price |
$211.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$188.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$199.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$199.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.31
|
| Rate for Payer: Healthfirst Commercial |
$209.74
|
| Rate for Payer: Healthfirst Essential Plan |
$471.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$199.25
|
| Rate for Payer: Healthfirst QHP |
$209.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$146.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$209.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$178.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$146.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$157.31
|
| Rate for Payer: SOMOS Essential |
$157.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.74
|
|
|
PR EXCISION NEUROMA SCIATIC NERVE
|
Professional
|
Both
|
$4,553.33
|
|
|
Service Code
|
HCPCS 64786
|
| Min. Negotiated Rate |
$843.52 |
| Max. Negotiated Rate |
$2,711.32 |
| Rate for Payer: Cash Price |
$1,214.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,205.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,084.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,084.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,144.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,205.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,144.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,205.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,205.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$903.77
|
| Rate for Payer: Healthfirst Commercial |
$1,205.03
|
| Rate for Payer: Healthfirst Essential Plan |
$2,711.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,144.78
|
| Rate for Payer: Healthfirst QHP |
$1,205.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$843.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,205.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,024.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$843.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,205.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$903.77
|
| Rate for Payer: SOMOS Essential |
$903.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,205.03
|
|
|
PR EXCISION OF BULBOURETHRAL GLAND
|
Professional
|
Both
|
$1,669.71
|
|
|
Service Code
|
HCPCS 53250
|
| Min. Negotiated Rate |
$319.82 |
| Max. Negotiated Rate |
$1,027.98 |
| Rate for Payer: Cash Price |
$457.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$456.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$411.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$411.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$456.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$456.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$456.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$342.66
|
| Rate for Payer: Healthfirst Commercial |
$456.88
|
| Rate for Payer: Healthfirst Essential Plan |
$1,027.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$434.04
|
| Rate for Payer: Healthfirst QHP |
$456.88
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$319.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$456.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$388.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$319.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$456.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$342.66
|
| Rate for Payer: SOMOS Essential |
$342.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$456.88
|
|
