|
PR EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH
|
Professional
|
Both
|
$4,689.20
|
|
|
Service Code
|
HCPCS 45130
|
| Min. Negotiated Rate |
$877.33 |
| Max. Negotiated Rate |
$2,819.99 |
| Rate for Payer: Cash Price |
$1,263.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,253.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,128.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,128.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,190.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,253.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,190.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,253.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,253.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$940.00
|
| Rate for Payer: Healthfirst Commercial |
$1,253.33
|
| Rate for Payer: Healthfirst Essential Plan |
$2,819.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,190.66
|
| Rate for Payer: Healthfirst QHP |
$1,253.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$877.33
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,253.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,065.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$877.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,253.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$940.00
|
| Rate for Payer: SOMOS Essential |
$940.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,253.33
|
|
|
PR EXC RCT TUM INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$3,584.81
|
|
|
Service Code
|
HCPCS 45172
|
| Min. Negotiated Rate |
$672.96 |
| Max. Negotiated Rate |
$2,163.08 |
| Rate for Payer: Cash Price |
$968.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$961.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$865.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$913.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$961.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$913.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$961.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$961.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$721.03
|
| Rate for Payer: Healthfirst Commercial |
$961.37
|
| Rate for Payer: Healthfirst Essential Plan |
$2,163.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$913.30
|
| Rate for Payer: Healthfirst QHP |
$961.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$672.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$961.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$817.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$672.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$961.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$721.03
|
| Rate for Payer: SOMOS Essential |
$721.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$961.37
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$2,710.51
|
|
|
Service Code
|
HCPCS 45171
|
| Min. Negotiated Rate |
$508.31 |
| Max. Negotiated Rate |
$1,633.86 |
| Rate for Payer: Cash Price |
$730.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$653.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$653.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$689.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$689.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$726.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$544.62
|
| Rate for Payer: Healthfirst Commercial |
$726.16
|
| Rate for Payer: Healthfirst Essential Plan |
$1,633.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$689.85
|
| Rate for Payer: Healthfirst QHP |
$726.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$508.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$617.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$508.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$544.62
|
| Rate for Payer: SOMOS Essential |
$544.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.16
|
|
|
PR EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL
|
Professional
|
Both
|
$4,643.59
|
|
|
Service Code
|
HCPCS 45160
|
| Min. Negotiated Rate |
$862.08 |
| Max. Negotiated Rate |
$2,770.97 |
| Rate for Payer: Cash Price |
$1,239.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,231.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,108.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,108.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,169.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,231.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,169.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,231.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,231.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$923.65
|
| Rate for Payer: Healthfirst Commercial |
$1,231.54
|
| Rate for Payer: Healthfirst Essential Plan |
$2,770.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,169.96
|
| Rate for Payer: Healthfirst QHP |
$1,231.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$862.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,231.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,046.81
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$862.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,231.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$923.65
|
| Rate for Payer: SOMOS Essential |
$923.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,231.54
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR
|
Professional
|
Both
|
$3,996.34
|
|
|
Service Code
|
HCPCS 15936
|
| Min. Negotiated Rate |
$736.13 |
| Max. Negotiated Rate |
$2,366.14 |
| Rate for Payer: Cash Price |
$1,069.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,051.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$946.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$946.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$999.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,051.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$999.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,051.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,051.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$788.72
|
| Rate for Payer: Healthfirst Commercial |
$1,051.62
|
| Rate for Payer: Healthfirst Essential Plan |
$2,366.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$999.04
|
| Rate for Payer: Healthfirst QHP |
$1,051.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$736.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,051.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$893.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$736.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,051.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$788.72
|
| Rate for Payer: SOMOS Essential |
$788.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,051.62
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC
|
Professional
|
Both
|
$4,597.92
|
|
|
Service Code
|
HCPCS 15937
|
| Min. Negotiated Rate |
$802.35 |
| Max. Negotiated Rate |
$2,578.97 |
| Rate for Payer: Cash Price |
$1,228.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,146.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,031.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,031.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,088.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,146.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,088.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,146.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,146.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$859.66
|
| Rate for Payer: Healthfirst Commercial |
$1,146.21
|
| Rate for Payer: Healthfirst Essential Plan |
$2,578.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,088.90
|
| Rate for Payer: Healthfirst QHP |
$1,146.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$802.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,146.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$974.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$802.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,146.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$859.66
|
| Rate for Payer: SOMOS Essential |
$859.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,146.21
|
|
|
PR EXC SACRAL PRESSURE ULC W/PRIM SUTR W/OSTECTOMY
|
Professional
|
Both
|
$3,878.67
|
|
|
Service Code
|
HCPCS 15933
|
| Min. Negotiated Rate |
$725.42 |
| Max. Negotiated Rate |
$2,331.70 |
| Rate for Payer: Cash Price |
$1,043.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,036.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$932.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$932.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$984.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,036.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$984.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,036.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,036.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$777.23
|
| Rate for Payer: Healthfirst Commercial |
$1,036.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,331.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$984.49
|
| Rate for Payer: Healthfirst QHP |
$1,036.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$725.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,036.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$880.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$725.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,036.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$777.23
|
| Rate for Payer: SOMOS Essential |
$777.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,036.31
|
|
|
PR EXC SACRAL PR ULCER W/SKN FLAP CLSR W/OSTECTOMY
|
Professional
|
Both
|
$5,052.04
|
|
|
Service Code
|
HCPCS 15935
|
| Min. Negotiated Rate |
$950.36 |
| Max. Negotiated Rate |
$3,054.74 |
| Rate for Payer: Cash Price |
$1,362.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,357.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,221.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,221.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,289.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,357.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,289.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,357.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,357.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,018.25
|
| Rate for Payer: Healthfirst Commercial |
$1,357.66
|
| Rate for Payer: Healthfirst Essential Plan |
$3,054.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,289.78
|
| Rate for Payer: Healthfirst QHP |
$1,357.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$950.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,357.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,154.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$950.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,357.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,018.25
|
| Rate for Payer: SOMOS Essential |
$1,018.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,357.66
|
|
|
PR EXC SUBLINGUAL SALIVARY CYST RANULA
|
Professional
|
Both
|
$1,474.27
|
|
|
Service Code
|
HCPCS 42408
|
| Min. Negotiated Rate |
$282.20 |
| Max. Negotiated Rate |
$907.07 |
| Rate for Payer: Cash Price |
$402.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$403.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$362.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$362.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$382.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$403.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$382.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$403.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$403.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$302.36
|
| Rate for Payer: Healthfirst Commercial |
$403.14
|
| Rate for Payer: Healthfirst Essential Plan |
$907.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$382.98
|
| Rate for Payer: Healthfirst QHP |
$403.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$282.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$403.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$342.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$282.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$403.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$302.36
|
| Rate for Payer: SOMOS Essential |
$302.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$403.14
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Professional
|
Both
|
$2,373.77
|
|
|
Service Code
|
HCPCS 25109
|
| Min. Negotiated Rate |
$450.43 |
| Max. Negotiated Rate |
$1,447.81 |
| Rate for Payer: Cash Price |
$644.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$643.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$579.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$579.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$611.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$643.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$611.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$643.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$643.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$482.60
|
| Rate for Payer: Healthfirst Commercial |
$643.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,447.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$611.30
|
| Rate for Payer: Healthfirst QHP |
$643.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$450.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$643.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$546.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$450.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$643.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$482.60
|
| Rate for Payer: SOMOS Essential |
$482.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$643.47
|
|
|
PR EXC THROMBOSED HEMORRHOID XTRNL
|
Professional
|
Both
|
$490.60
|
|
|
Service Code
|
HCPCS 46320
|
| Min. Negotiated Rate |
$92.96 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Cash Price |
$134.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.60
|
| Rate for Payer: Healthfirst Commercial |
$132.80
|
| Rate for Payer: Healthfirst Essential Plan |
$298.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.16
|
| Rate for Payer: Healthfirst QHP |
$132.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$92.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$132.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$112.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$92.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.60
|
| Rate for Payer: SOMOS Essential |
$99.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$132.80
|
|
|
PR EXC TRACHEAL STENOSIS&ANAST CERVICOTHORACIC
|
Professional
|
Both
|
$6,177.01
|
|
|
Service Code
|
HCPCS 31781
|
| Min. Negotiated Rate |
$1,155.62 |
| Max. Negotiated Rate |
$3,714.50 |
| Rate for Payer: Cash Price |
$1,667.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,650.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,485.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,485.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,568.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,650.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,568.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,650.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,650.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,238.17
|
| Rate for Payer: Healthfirst Commercial |
$1,650.89
|
| Rate for Payer: Healthfirst Essential Plan |
$3,714.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,568.35
|
| Rate for Payer: Healthfirst QHP |
$1,650.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,155.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,650.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,403.26
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,155.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,650.89
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,238.17
|
| Rate for Payer: SOMOS Essential |
$1,238.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,650.89
|
|
|
PR EXC TRCHNTRIC PR ULCER W/PRIM SUTR W/OSTECTOMY
|
Professional
|
Both
|
$3,931.38
|
|
|
Service Code
|
HCPCS 15951
|
| Min. Negotiated Rate |
$740.12 |
| Max. Negotiated Rate |
$2,378.95 |
| Rate for Payer: Cash Price |
$1,062.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,057.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$951.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$951.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,004.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,057.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,004.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,057.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,057.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$792.98
|
| Rate for Payer: Healthfirst Commercial |
$1,057.31
|
| Rate for Payer: Healthfirst Essential Plan |
$2,378.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,004.44
|
| Rate for Payer: Healthfirst QHP |
$1,057.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$740.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,057.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$898.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$740.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,057.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$792.98
|
| Rate for Payer: SOMOS Essential |
$792.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,057.31
|
|
|
PR EXC TRCHNTRIC PR ULC MUSC/MYOQ FLAP/SKIN W/OSTC
|
Professional
|
Both
|
$5,180.32
|
|
|
Service Code
|
HCPCS 15958
|
| Min. Negotiated Rate |
$957.38 |
| Max. Negotiated Rate |
$3,077.30 |
| Rate for Payer: Cash Price |
$1,389.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,367.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,230.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,230.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,299.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,367.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,299.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,367.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,367.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,025.77
|
| Rate for Payer: Healthfirst Commercial |
$1,367.69
|
| Rate for Payer: Healthfirst Essential Plan |
$3,077.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,299.31
|
| Rate for Payer: Healthfirst QHP |
$1,367.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$957.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,367.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,162.54
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$957.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,367.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,025.77
|
| Rate for Payer: SOMOS Essential |
$1,025.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,367.69
|
|
|
PR EXC TRCHNTRIC PR ULC W/SKN FLAP CLSR W/OSTECTOMY
|
Professional
|
Both
|
$4,415.53
|
|
|
Service Code
|
HCPCS 15953
|
| Min. Negotiated Rate |
$830.54 |
| Max. Negotiated Rate |
$2,669.58 |
| Rate for Payer: Cash Price |
$1,191.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,186.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,067.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,067.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,127.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,186.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,127.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,186.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,186.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$889.86
|
| Rate for Payer: Healthfirst Commercial |
$1,186.48
|
| Rate for Payer: Healthfirst Essential Plan |
$2,669.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,127.16
|
| Rate for Payer: Healthfirst QHP |
$1,186.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$830.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,186.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,008.51
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$830.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,186.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$889.86
|
| Rate for Payer: SOMOS Essential |
$889.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,186.48
|
|
|
PR EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR
|
Professional
|
Both
|
$2,786.81
|
|
|
Service Code
|
HCPCS 15950
|
| Min. Negotiated Rate |
$525.42 |
| Max. Negotiated Rate |
$1,688.85 |
| Rate for Payer: Cash Price |
$754.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$750.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$675.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$675.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$713.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$750.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$713.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$750.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$750.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$562.95
|
| Rate for Payer: Healthfirst Commercial |
$750.60
|
| Rate for Payer: Healthfirst Essential Plan |
$1,688.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$713.07
|
| Rate for Payer: Healthfirst QHP |
$750.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$525.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$750.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$638.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$525.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$750.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$562.95
|
| Rate for Payer: SOMOS Essential |
$562.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$750.60
|
|
|
PR EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN
|
Professional
|
Both
|
$5,118.23
|
|
|
Service Code
|
HCPCS 15956
|
| Min. Negotiated Rate |
$960.60 |
| Max. Negotiated Rate |
$3,087.65 |
| Rate for Payer: Cash Price |
$1,412.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,372.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,235.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,235.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,303.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,372.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,303.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,372.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,372.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,029.22
|
| Rate for Payer: Healthfirst Commercial |
$1,372.29
|
| Rate for Payer: Healthfirst Essential Plan |
$3,087.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,303.68
|
| Rate for Payer: Healthfirst QHP |
$1,372.29
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$960.60
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,372.29
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,166.45
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$960.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,372.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,029.22
|
| Rate for Payer: SOMOS Essential |
$1,029.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,372.29
|
|
|
PR EXC TROCHANTERIC PR ULCER W/SKIN FLAP CLOSURE
|
Professional
|
Both
|
$4,010.65
|
|
|
Service Code
|
HCPCS 15952
|
| Min. Negotiated Rate |
$754.61 |
| Max. Negotiated Rate |
$2,425.52 |
| Rate for Payer: Cash Price |
$1,082.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,078.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$970.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$970.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,024.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,078.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,024.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,078.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,078.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$808.51
|
| Rate for Payer: Healthfirst Commercial |
$1,078.01
|
| Rate for Payer: Healthfirst Essential Plan |
$2,425.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,024.11
|
| Rate for Payer: Healthfirst QHP |
$1,078.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$754.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,078.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$916.31
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$754.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,078.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$808.51
|
| Rate for Payer: SOMOS Essential |
$808.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,078.01
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Professional
|
Both
|
$2,385.15
|
|
|
Service Code
|
HCPCS 25073
|
| Min. Negotiated Rate |
$450.46 |
| Max. Negotiated Rate |
$1,447.92 |
| Rate for Payer: Cash Price |
$644.36
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$643.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$579.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$579.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$611.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$643.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$611.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$643.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$643.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$482.64
|
| Rate for Payer: Healthfirst Commercial |
$643.52
|
| Rate for Payer: Healthfirst Essential Plan |
$1,447.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$611.34
|
| Rate for Payer: Healthfirst QHP |
$643.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$450.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$643.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$546.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$450.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$643.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$482.64
|
| Rate for Payer: SOMOS Essential |
$482.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$643.52
|
|
|
PR EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>
|
Professional
|
Both
|
$2,004.14
|
|
|
Service Code
|
HCPCS 21552
|
| Min. Negotiated Rate |
$375.47 |
| Max. Negotiated Rate |
$1,206.86 |
| Rate for Payer: Cash Price |
$539.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$536.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$482.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$482.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$509.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$536.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$509.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$536.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$536.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$402.29
|
| Rate for Payer: Healthfirst Commercial |
$536.38
|
| Rate for Payer: Healthfirst Essential Plan |
$1,206.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$509.56
|
| Rate for Payer: Healthfirst QHP |
$536.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$375.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$536.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$455.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$375.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$536.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$402.29
|
| Rate for Payer: SOMOS Essential |
$402.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$536.38
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Professional
|
Both
|
$3,309.29
|
|
|
Service Code
|
HCPCS 21933
|
| Min. Negotiated Rate |
$617.39 |
| Max. Negotiated Rate |
$1,984.48 |
| Rate for Payer: Cash Price |
$887.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$881.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$793.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$793.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$837.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$881.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$837.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$881.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$881.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$661.49
|
| Rate for Payer: Healthfirst Commercial |
$881.99
|
| Rate for Payer: Healthfirst Essential Plan |
$1,984.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$837.89
|
| Rate for Payer: Healthfirst QHP |
$881.99
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$617.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$881.99
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$749.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$617.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$881.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$661.49
|
| Rate for Payer: SOMOS Essential |
$661.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$881.99
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM
|
Professional
|
Both
|
$2,980.04
|
|
|
Service Code
|
HCPCS 21932
|
| Min. Negotiated Rate |
$556.80 |
| Max. Negotiated Rate |
$1,789.72 |
| Rate for Payer: Cash Price |
$795.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$795.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$715.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$715.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$755.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$795.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$755.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$795.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$795.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$596.57
|
| Rate for Payer: Healthfirst Commercial |
$795.43
|
| Rate for Payer: Healthfirst Essential Plan |
$1,789.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$755.66
|
| Rate for Payer: Healthfirst QHP |
$795.43
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$556.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$795.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$676.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$556.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$795.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$596.57
|
| Rate for Payer: SOMOS Essential |
$596.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$795.43
|
|
|
PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/>
|
Professional
|
Both
|
$2,294.95
|
|
|
Service Code
|
HCPCS 21014
|
| Min. Negotiated Rate |
$431.53 |
| Max. Negotiated Rate |
$1,387.06 |
| Rate for Payer: Cash Price |
$619.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$616.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$554.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$554.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$585.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$616.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$585.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$616.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$616.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$462.35
|
| Rate for Payer: Healthfirst Commercial |
$616.47
|
| Rate for Payer: Healthfirst Essential Plan |
$1,387.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$585.65
|
| Rate for Payer: Healthfirst QHP |
$616.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$431.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$616.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$524.00
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$431.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$616.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$462.35
|
| Rate for Payer: SOMOS Essential |
$462.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$616.47
|
|
|
PR EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM
|
Professional
|
Both
|
$1,762.32
|
|
|
Service Code
|
HCPCS 21013
|
| Min. Negotiated Rate |
$331.03 |
| Max. Negotiated Rate |
$1,064.03 |
| Rate for Payer: Cash Price |
$476.59
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$472.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$425.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$425.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$449.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$472.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$449.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$472.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$472.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$354.68
|
| Rate for Payer: Healthfirst Commercial |
$472.90
|
| Rate for Payer: Healthfirst Essential Plan |
$1,064.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$449.25
|
| Rate for Payer: Healthfirst QHP |
$472.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$331.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$472.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$401.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$331.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$472.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$354.68
|
| Rate for Payer: SOMOS Essential |
$354.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$472.90
|
|
|
PR EXC TUMOR SOFT TISS FOREARM AND/WRIST SUBQ 3CM/>
|
Professional
|
Both
|
$1,889.97
|
|
|
Service Code
|
HCPCS 25071
|
| Min. Negotiated Rate |
$356.15 |
| Max. Negotiated Rate |
$1,144.76 |
| Rate for Payer: Cash Price |
$510.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$508.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$457.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$457.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$483.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$508.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$483.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$508.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$508.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$381.58
|
| Rate for Payer: Healthfirst Commercial |
$508.78
|
| Rate for Payer: Healthfirst Essential Plan |
$1,144.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$483.34
|
| Rate for Payer: Healthfirst QHP |
$508.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$356.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$508.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$432.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$356.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$508.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$381.58
|
| Rate for Payer: SOMOS Essential |
$381.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$508.78
|
|
