|
PR EXCISION OF PENILE PLAQUE
|
Professional
|
Both
|
$2,616.22
|
|
|
Service Code
|
HCPCS 54110
|
| Min. Negotiated Rate |
$499.07 |
| Max. Negotiated Rate |
$1,604.16 |
| Rate for Payer: Cash Price |
$717.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$712.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$641.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$641.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$677.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$712.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$677.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$712.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$712.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$534.72
|
| Rate for Payer: Healthfirst Commercial |
$712.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,604.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$677.31
|
| Rate for Payer: Healthfirst QHP |
$712.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$499.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$712.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$606.02
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$499.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$712.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$534.72
|
| Rate for Payer: SOMOS Essential |
$534.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$712.96
|
|
|
PR EXCISION OLECRANON BURSA
|
Professional
|
Both
|
$1,601.67
|
|
|
Service Code
|
HCPCS 24105
|
| Min. Negotiated Rate |
$305.49 |
| Max. Negotiated Rate |
$981.92 |
| Rate for Payer: Cash Price |
$437.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$436.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$392.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$392.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$414.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$436.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$414.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$436.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$436.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$327.31
|
| Rate for Payer: Healthfirst Commercial |
$436.41
|
| Rate for Payer: Healthfirst Essential Plan |
$981.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.59
|
| Rate for Payer: Healthfirst QHP |
$436.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$305.49
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$436.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$370.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$305.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$436.41
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$327.31
|
| Rate for Payer: SOMOS Essential |
$327.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$436.41
|
|
|
PR EXCISION OR FULGURATION SKENES GLANDS
|
Professional
|
Both
|
$776.27
|
|
|
Service Code
|
HCPCS 53270
|
| Min. Negotiated Rate |
$149.11 |
| Max. Negotiated Rate |
$479.27 |
| Rate for Payer: Cash Price |
$213.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$213.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$213.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$213.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.76
|
| Rate for Payer: Healthfirst Commercial |
$213.01
|
| Rate for Payer: Healthfirst Essential Plan |
$479.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.36
|
| Rate for Payer: Healthfirst QHP |
$213.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$149.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$213.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$181.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$149.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$213.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.76
|
| Rate for Payer: SOMOS Essential |
$159.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$213.01
|
|
|
PR EXCISION PAROTID TUMOR/GLAND TOTAL EN BLOC RMVL
|
Professional
|
Both
|
$3,638.25
|
|
|
Service Code
|
HCPCS 42425
|
| Min. Negotiated Rate |
$681.27 |
| Max. Negotiated Rate |
$2,189.79 |
| Rate for Payer: Cash Price |
$982.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$973.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$875.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$875.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$924.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$973.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$924.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$973.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$973.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$729.93
|
| Rate for Payer: Healthfirst Commercial |
$973.24
|
| Rate for Payer: Healthfirst Essential Plan |
$2,189.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$924.58
|
| Rate for Payer: Healthfirst QHP |
$973.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$681.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$973.24
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$827.25
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$681.27
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$973.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$729.93
|
| Rate for Payer: SOMOS Essential |
$729.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$973.24
|
|
|
PR EXCISION PERINEPHRIC CYST
|
Professional
|
Both
|
$3,759.77
|
|
|
Service Code
|
HCPCS 50290
|
| Min. Negotiated Rate |
$715.10 |
| Max. Negotiated Rate |
$2,298.53 |
| Rate for Payer: Cash Price |
$1,028.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,021.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$919.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$919.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$970.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,021.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$970.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,021.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,021.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$766.18
|
| Rate for Payer: Healthfirst Commercial |
$1,021.57
|
| Rate for Payer: Healthfirst Essential Plan |
$2,298.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$970.49
|
| Rate for Payer: Healthfirst QHP |
$1,021.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$715.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,021.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$868.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$715.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,021.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$766.18
|
| Rate for Payer: SOMOS Essential |
$766.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,021.57
|
|
|
PR EXCISION PILONIDAL CYST/SINUS COMPLICATED
|
Professional
|
Both
|
$2,571.49
|
|
|
Service Code
|
HCPCS 11772
|
| Min. Negotiated Rate |
$483.11 |
| Max. Negotiated Rate |
$1,552.86 |
| Rate for Payer: Cash Price |
$694.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$690.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$621.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$621.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$655.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$690.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$655.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$690.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$690.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$517.62
|
| Rate for Payer: Healthfirst Commercial |
$690.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,552.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$655.65
|
| Rate for Payer: Healthfirst QHP |
$690.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$483.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$690.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$586.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$483.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$690.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$517.62
|
| Rate for Payer: SOMOS Essential |
$517.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$690.16
|
|
|
PR EXCISION PILONIDAL CYST/SINUS EXTENSIVE
|
Professional
|
Both
|
$2,004.28
|
|
|
Service Code
|
HCPCS 11771
|
| Min. Negotiated Rate |
$376.33 |
| Max. Negotiated Rate |
$1,209.62 |
| Rate for Payer: Cash Price |
$540.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$537.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$483.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$483.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$510.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$537.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$510.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$537.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$537.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$403.21
|
| Rate for Payer: Healthfirst Commercial |
$537.61
|
| Rate for Payer: Healthfirst Essential Plan |
$1,209.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$510.73
|
| Rate for Payer: Healthfirst QHP |
$537.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$376.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$537.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$456.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$376.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$537.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$403.21
|
| Rate for Payer: SOMOS Essential |
$403.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$537.61
|
|
|
PR EXCISION PILONIDAL CYST/SINUS SIMPLE
|
Professional
|
Both
|
$825.23
|
|
|
Service Code
|
HCPCS 11770
|
| Min. Negotiated Rate |
$153.69 |
| Max. Negotiated Rate |
$493.99 |
| Rate for Payer: Cash Price |
$222.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$219.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$197.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$197.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$208.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$219.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$208.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$219.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$219.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$164.66
|
| Rate for Payer: Healthfirst Commercial |
$219.55
|
| Rate for Payer: Healthfirst Essential Plan |
$493.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$208.57
|
| Rate for Payer: Healthfirst QHP |
$219.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$153.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$219.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$186.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$153.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$219.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$164.66
|
| Rate for Payer: SOMOS Essential |
$164.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$219.55
|
|
|
PR EXCISION PREPATELLAR BURSA
|
Professional
|
Both
|
$1,666.32
|
|
|
Service Code
|
HCPCS 27340
|
| Min. Negotiated Rate |
$317.18 |
| Max. Negotiated Rate |
$1,019.52 |
| Rate for Payer: Cash Price |
$455.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$453.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$407.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$407.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$430.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$453.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$430.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$453.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$453.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$339.84
|
| Rate for Payer: Healthfirst Commercial |
$453.12
|
| Rate for Payer: Healthfirst Essential Plan |
$1,019.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$430.46
|
| Rate for Payer: Healthfirst QHP |
$453.12
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$317.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$453.12
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$385.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$317.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$453.12
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$339.84
|
| Rate for Payer: SOMOS Essential |
$339.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$453.12
|
|
|
PR EXCISION RADIAL HEAD
|
Professional
|
Both
|
$2,278.99
|
|
|
Service Code
|
HCPCS 24130
|
| Min. Negotiated Rate |
$432.14 |
| Max. Negotiated Rate |
$1,389.02 |
| Rate for Payer: Cash Price |
$615.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$617.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$555.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$555.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$586.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$617.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$586.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$617.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$617.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$463.00
|
| Rate for Payer: Healthfirst Commercial |
$617.34
|
| Rate for Payer: Healthfirst Essential Plan |
$1,389.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$586.47
|
| Rate for Payer: Healthfirst QHP |
$617.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$432.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$617.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$524.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$432.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$617.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$463.00
|
| Rate for Payer: SOMOS Essential |
$463.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$617.34
|
|
|
PR EXCISION & REPAIR EYELID < ONE-FOURTH LID MARGIN
|
Professional
|
Both
|
$1,868.93
|
|
|
Service Code
|
HCPCS 67961
|
| Min. Negotiated Rate |
$358.04 |
| Max. Negotiated Rate |
$1,150.83 |
| Rate for Payer: Cash Price |
$515.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$511.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$460.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$460.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$485.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$511.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$485.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$511.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$511.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$383.61
|
| Rate for Payer: Healthfirst Commercial |
$511.48
|
| Rate for Payer: Healthfirst Essential Plan |
$1,150.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$485.91
|
| Rate for Payer: Healthfirst QHP |
$511.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$358.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$511.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$434.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$358.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$511.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$383.61
|
| Rate for Payer: SOMOS Essential |
$383.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$511.48
|
|
|
PR EXCISION & REPAIR EYELID ONE-FOURTH LID MARGIN
|
Professional
|
Both
|
$2,690.28
|
|
|
Service Code
|
HCPCS 67966
|
| Min. Negotiated Rate |
$511.99 |
| Max. Negotiated Rate |
$1,645.69 |
| Rate for Payer: Cash Price |
$740.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$731.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$658.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$658.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$694.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$731.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$694.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$731.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$731.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$548.57
|
| Rate for Payer: Healthfirst Commercial |
$731.42
|
| Rate for Payer: Healthfirst Essential Plan |
$1,645.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$694.85
|
| Rate for Payer: Healthfirst QHP |
$731.42
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$511.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$731.42
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$621.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$511.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$731.42
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$548.57
|
| Rate for Payer: SOMOS Essential |
$548.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$731.42
|
|
|
PR EXCISION RIB PARTIAL
|
Professional
|
Both
|
$2,515.63
|
|
|
Service Code
|
HCPCS 21600
|
| Min. Negotiated Rate |
$480.40 |
| Max. Negotiated Rate |
$1,544.13 |
| Rate for Payer: Cash Price |
$682.07
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$686.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$617.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$651.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$686.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$651.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$686.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$686.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$514.71
|
| Rate for Payer: Healthfirst Commercial |
$686.28
|
| Rate for Payer: Healthfirst Essential Plan |
$1,544.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$651.97
|
| Rate for Payer: Healthfirst QHP |
$686.28
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$480.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$686.28
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$583.34
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$480.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$686.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$514.71
|
| Rate for Payer: SOMOS Essential |
$514.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$686.28
|
|
|
PR EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE
|
Professional
|
Both
|
$3,160.61
|
|
|
Service Code
|
HCPCS 15931
|
| Min. Negotiated Rate |
$589.54 |
| Max. Negotiated Rate |
$1,894.95 |
| Rate for Payer: Cash Price |
$845.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$842.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$757.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$757.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$800.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$842.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$800.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$842.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$842.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$631.65
|
| Rate for Payer: Healthfirst Commercial |
$842.20
|
| Rate for Payer: Healthfirst Essential Plan |
$1,894.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$800.09
|
| Rate for Payer: Healthfirst QHP |
$842.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$589.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$842.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$715.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$589.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$842.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$631.65
|
| Rate for Payer: SOMOS Essential |
$631.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$842.20
|
|
|
PR EXCISION SACRAL PRESSURE ULCER W/SKIN FLAP CLSR
|
Professional
|
Both
|
$4,199.79
|
|
|
Service Code
|
HCPCS 15934
|
| Min. Negotiated Rate |
$809.60 |
| Max. Negotiated Rate |
$2,602.28 |
| Rate for Payer: Cash Price |
$1,162.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,156.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,040.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,040.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,098.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,156.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,098.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,156.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$867.43
|
| Rate for Payer: Healthfirst Commercial |
$1,156.57
|
| Rate for Payer: Healthfirst Essential Plan |
$2,602.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,098.74
|
| Rate for Payer: Healthfirst QHP |
$1,156.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$809.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,156.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$983.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$809.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,156.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$867.43
|
| Rate for Payer: SOMOS Essential |
$867.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,156.57
|
|
|
PR EXCISION SINGLE EXTERNAL PAPILLA OR TAG ANUS
|
Professional
|
Both
|
$531.13
|
|
|
Service Code
|
HCPCS 46220
|
| Min. Negotiated Rate |
$100.28 |
| Max. Negotiated Rate |
$322.33 |
| Rate for Payer: Cash Price |
$144.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$143.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$128.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$128.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$143.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.44
|
| Rate for Payer: Healthfirst Commercial |
$143.26
|
| Rate for Payer: Healthfirst Essential Plan |
$322.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$136.10
|
| Rate for Payer: Healthfirst QHP |
$143.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$100.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$143.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$121.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$100.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$143.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.44
|
| Rate for Payer: SOMOS Essential |
$107.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.26
|
|
|
PR EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY
|
Professional
|
Both
|
$5,148.85
|
|
|
Service Code
|
HCPCS 15830
|
| Min. Negotiated Rate |
$968.65 |
| Max. Negotiated Rate |
$3,113.51 |
| Rate for Payer: Cash Price |
$1,385.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,383.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,245.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,245.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,314.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,383.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,314.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,383.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,383.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,037.84
|
| Rate for Payer: Healthfirst Commercial |
$1,383.78
|
| Rate for Payer: Healthfirst Essential Plan |
$3,113.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,314.59
|
| Rate for Payer: Healthfirst QHP |
$1,383.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$968.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,383.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,176.21
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$968.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,383.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,037.84
|
| Rate for Payer: SOMOS Essential |
$1,037.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,383.78
|
|
|
PR EXCISION SOFT TIS LESION EXTERNAL AUDITORY CANAL
|
Professional
|
Both
|
$1,117.76
|
|
|
Service Code
|
HCPCS 69145
|
| Min. Negotiated Rate |
$208.87 |
| Max. Negotiated Rate |
$671.38 |
| Rate for Payer: Cash Price |
$304.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$298.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$268.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$268.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$283.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$298.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$283.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$298.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$298.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$223.79
|
| Rate for Payer: Healthfirst Commercial |
$298.39
|
| Rate for Payer: Healthfirst Essential Plan |
$671.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$283.47
|
| Rate for Payer: Healthfirst QHP |
$298.39
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$208.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$298.39
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$253.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$208.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$298.39
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$223.79
|
| Rate for Payer: SOMOS Essential |
$223.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$298.39
|
|
|
PR EXCISION SPERMATOCELE W/WO EPIDIDYMECTOMY
|
Professional
|
Both
|
$1,362.59
|
|
|
Service Code
|
HCPCS 54840
|
| Min. Negotiated Rate |
$259.22 |
| Max. Negotiated Rate |
$833.22 |
| Rate for Payer: Cash Price |
$372.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$370.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$333.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$333.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$351.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$370.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$351.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$370.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$277.74
|
| Rate for Payer: Healthfirst Commercial |
$370.32
|
| Rate for Payer: Healthfirst Essential Plan |
$833.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$351.80
|
| Rate for Payer: Healthfirst QHP |
$370.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$259.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$370.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$314.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$259.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$370.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$277.74
|
| Rate for Payer: SOMOS Essential |
$277.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.32
|
|
|
PR EXCISION SUBMANDIBULAR SUBMAXILLARY GLAND
|
Professional
|
Both
|
$1,803.03
|
|
|
Service Code
|
HCPCS 42440
|
| Min. Negotiated Rate |
$338.57 |
| Max. Negotiated Rate |
$1,088.26 |
| Rate for Payer: Cash Price |
$489.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$483.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$435.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$435.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$459.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$483.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$459.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$483.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$362.75
|
| Rate for Payer: Healthfirst Commercial |
$483.67
|
| Rate for Payer: Healthfirst Essential Plan |
$1,088.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$459.49
|
| Rate for Payer: Healthfirst QHP |
$483.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$338.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$483.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$411.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$338.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$483.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$362.75
|
| Rate for Payer: SOMOS Essential |
$362.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$483.67
|
|
|
PR EXCISION/SURGICAL PLANING SKIN NOSE RHINOPHYMA
|
Professional
|
Both
|
$1,811.39
|
|
|
Service Code
|
HCPCS 30120
|
| Min. Negotiated Rate |
$342.57 |
| Max. Negotiated Rate |
$1,101.11 |
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$489.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$440.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$440.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$464.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$489.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$464.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$489.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$489.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$367.04
|
| Rate for Payer: Healthfirst Commercial |
$489.38
|
| Rate for Payer: Healthfirst Essential Plan |
$1,101.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$464.91
|
| Rate for Payer: Healthfirst QHP |
$489.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$342.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$489.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$415.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$342.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$489.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$367.04
|
| Rate for Payer: SOMOS Essential |
$367.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$489.38
|
|
|
PR EXCISION SYNOVIAL CYST POPLITEAL SPACE
|
Professional
|
Both
|
$2,159.15
|
|
|
Service Code
|
HCPCS 27345
|
| Min. Negotiated Rate |
$411.47 |
| Max. Negotiated Rate |
$1,322.57 |
| Rate for Payer: Cash Price |
$586.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$587.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$529.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$529.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$558.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$587.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$558.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$587.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$587.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$440.86
|
| Rate for Payer: Healthfirst Commercial |
$587.81
|
| Rate for Payer: Healthfirst Essential Plan |
$1,322.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$558.42
|
| Rate for Payer: Healthfirst QHP |
$587.81
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$411.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$587.81
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$499.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$411.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$587.81
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$440.86
|
| Rate for Payer: SOMOS Essential |
$440.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$587.81
|
|
|
PR EXCISION TENDON FINGER FLEXOR/EXTENSOR EACH
|
Professional
|
Both
|
$1,992.06
|
|
|
Service Code
|
HCPCS 26180
|
| Min. Negotiated Rate |
$380.25 |
| Max. Negotiated Rate |
$1,222.24 |
| Rate for Payer: Cash Price |
$543.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$543.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$488.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$488.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$516.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$543.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$516.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$543.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$543.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$407.42
|
| Rate for Payer: Healthfirst Commercial |
$543.22
|
| Rate for Payer: Healthfirst Essential Plan |
$1,222.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$516.06
|
| Rate for Payer: Healthfirst QHP |
$543.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$380.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$543.22
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$461.74
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$380.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$543.22
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$407.42
|
| Rate for Payer: SOMOS Essential |
$407.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$543.22
|
|
|
PR EXCISION TENDON PALM FLEXOR/EXTENSOR SINGLE EACH
|
Professional
|
Both
|
$1,811.39
|
|
|
Service Code
|
HCPCS 26170
|
| Min. Negotiated Rate |
$343.31 |
| Max. Negotiated Rate |
$1,103.49 |
| Rate for Payer: Cash Price |
$493.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$490.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$441.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$441.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$465.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$490.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$465.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$490.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$490.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$367.83
|
| Rate for Payer: Healthfirst Commercial |
$490.44
|
| Rate for Payer: Healthfirst Essential Plan |
$1,103.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$465.92
|
| Rate for Payer: Healthfirst QHP |
$490.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$343.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$490.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$416.87
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$343.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$490.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$367.83
|
| Rate for Payer: SOMOS Essential |
$367.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$490.44
|
|
|
PR EXCISION THYROGLOSSAL DUCT CYST/SINUS
|
Professional
|
Both
|
$1,970.57
|
|
|
Service Code
|
HCPCS 60280
|
| Min. Negotiated Rate |
$371.81 |
| Max. Negotiated Rate |
$1,195.09 |
| Rate for Payer: Cash Price |
$536.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$531.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$478.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$478.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$504.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$531.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$504.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$531.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$531.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$398.36
|
| Rate for Payer: Healthfirst Commercial |
$531.15
|
| Rate for Payer: Healthfirst Essential Plan |
$1,195.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$504.59
|
| Rate for Payer: Healthfirst QHP |
$531.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$371.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$531.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$451.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$371.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$531.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$398.36
|
| Rate for Payer: SOMOS Essential |
$398.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$531.15
|
|
