|
PR DEMONSTRATE USE HOME INR MON
|
Professional
|
Both
|
$423.50
|
|
|
Service Code
|
HCPCS G0248
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$263.20 |
| Rate for Payer: Cash Price |
$118.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$116.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$105.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$111.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$116.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$87.73
|
| Rate for Payer: Healthfirst Commercial |
$116.98
|
| Rate for Payer: Healthfirst Essential Plan |
$263.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$111.13
|
| Rate for Payer: Healthfirst QHP |
$116.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$81.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$116.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$99.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$81.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$116.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$87.73
|
| Rate for Payer: SOMOS Essential |
$87.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$116.98
|
|
|
PR DENOSUMAB INJECTION
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS J0897
|
| Min. Negotiated Rate |
$20.57 |
| Max. Negotiated Rate |
$66.11 |
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$26.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$27.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.04
|
| Rate for Payer: Healthfirst Commercial |
$29.38
|
| Rate for Payer: Healthfirst Essential Plan |
$66.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.91
|
| Rate for Payer: Healthfirst QHP |
$29.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$20.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$29.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$24.97
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$20.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.04
|
| Rate for Payer: SOMOS Essential |
$22.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.38
|
|
|
PR DEPRESSION SCREEN ANNUAL
|
Professional
|
Both
|
$36.79
|
|
|
Service Code
|
HCPCS G0444
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Cash Price |
$10.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.44
|
| Rate for Payer: Healthfirst Commercial |
$9.92
|
| Rate for Payer: Healthfirst Essential Plan |
$22.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.42
|
| Rate for Payer: Healthfirst QHP |
$9.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$8.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.44
|
| Rate for Payer: SOMOS Essential |
$7.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.92
|
|
|
PR DERMABRASION REGIONAL OTHER THAN FACE
|
Professional
|
Both
|
$1,553.37
|
|
|
Service Code
|
HCPCS 15782
|
| Min. Negotiated Rate |
$299.83 |
| Max. Negotiated Rate |
$963.74 |
| Rate for Payer: Cash Price |
$428.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$428.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$385.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$385.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$406.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$428.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$406.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$428.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$428.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$321.25
|
| Rate for Payer: Healthfirst Commercial |
$428.33
|
| Rate for Payer: Healthfirst Essential Plan |
$963.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$406.91
|
| Rate for Payer: Healthfirst QHP |
$428.33
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$299.83
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$428.33
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$364.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$299.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$428.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$321.25
|
| Rate for Payer: SOMOS Essential |
$321.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$428.33
|
|
|
PR DERMABRASION SEGMENTAL FACE
|
Professional
|
Both
|
$1,852.59
|
|
|
Service Code
|
HCPCS 15781
|
| Min. Negotiated Rate |
$340.63 |
| Max. Negotiated Rate |
$1,094.87 |
| Rate for Payer: Cash Price |
$500.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$486.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$437.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$437.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$462.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$486.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$462.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$486.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$486.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$364.96
|
| Rate for Payer: Healthfirst Commercial |
$486.61
|
| Rate for Payer: Healthfirst Essential Plan |
$1,094.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$462.28
|
| Rate for Payer: Healthfirst QHP |
$486.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$340.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$486.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$413.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$340.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$486.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$364.96
|
| Rate for Payer: SOMOS Essential |
$364.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$486.61
|
|
|
PR DERMABRASION SUPERFICIAL ANY SITE
|
Professional
|
Both
|
$1,490.69
|
|
|
Service Code
|
HCPCS 15783
|
| Min. Negotiated Rate |
$288.78 |
| Max. Negotiated Rate |
$928.22 |
| Rate for Payer: Cash Price |
$411.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$412.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$371.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$371.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$391.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$412.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$391.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$412.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$412.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$309.40
|
| Rate for Payer: Healthfirst Commercial |
$412.54
|
| Rate for Payer: Healthfirst Essential Plan |
$928.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.91
|
| Rate for Payer: Healthfirst QHP |
$412.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$288.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$412.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$350.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$288.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$412.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$309.40
|
| Rate for Payer: SOMOS Essential |
$309.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$412.54
|
|
|
PR DERMABRASION TOTAL FACE
|
Professional
|
Both
|
$2,788.66
|
|
|
Service Code
|
HCPCS 15780
|
| Min. Negotiated Rate |
$533.24 |
| Max. Negotiated Rate |
$1,713.98 |
| Rate for Payer: Cash Price |
$765.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$761.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$685.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$685.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$723.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$761.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$723.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$761.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$761.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$571.33
|
| Rate for Payer: Healthfirst Commercial |
$761.77
|
| Rate for Payer: Healthfirst Essential Plan |
$1,713.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$723.68
|
| Rate for Payer: Healthfirst QHP |
$761.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$533.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$761.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$647.50
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$533.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$761.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$571.33
|
| Rate for Payer: SOMOS Essential |
$571.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$761.77
|
|
|
PR DERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA
|
Professional
|
Both
|
$389.69
|
|
|
Service Code
|
HCPCS 15136
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$234.68 |
| Rate for Payer: Cash Price |
$103.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.22
|
| Rate for Payer: Healthfirst Commercial |
$104.30
|
| Rate for Payer: Healthfirst Essential Plan |
$234.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$99.08
|
| Rate for Payer: Healthfirst QHP |
$104.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.22
|
| Rate for Payer: SOMOS Essential |
$78.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.30
|
|
|
PR DERMAL AUTOGRAFT F/S/N/H/F/G/M/D GT 1ST 100
|
Professional
|
Both
|
$3,268.86
|
|
|
Service Code
|
HCPCS 15135
|
| Min. Negotiated Rate |
$613.19 |
| Max. Negotiated Rate |
$1,970.95 |
| Rate for Payer: Cash Price |
$880.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$875.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$788.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$788.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$832.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$875.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$832.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$875.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$875.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$656.99
|
| Rate for Payer: Healthfirst Commercial |
$875.98
|
| Rate for Payer: Healthfirst Essential Plan |
$1,970.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$832.18
|
| Rate for Payer: Healthfirst QHP |
$875.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$613.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$875.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$744.58
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$613.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$875.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$656.99
|
| Rate for Payer: SOMOS Essential |
$656.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$875.98
|
|
|
PR DERMAL AUTOGRAFT TRUNK/ARM/LEG 1ST 100 CM
|
Professional
|
Both
|
$2,599.21
|
|
|
Service Code
|
HCPCS 15130
|
| Min. Negotiated Rate |
$492.35 |
| Max. Negotiated Rate |
$1,582.56 |
| Rate for Payer: Cash Price |
$705.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$703.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$633.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$633.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$668.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$703.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$668.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$703.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$703.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$527.52
|
| Rate for Payer: Healthfirst Commercial |
$703.36
|
| Rate for Payer: Healthfirst Essential Plan |
$1,582.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$668.19
|
| Rate for Payer: Healthfirst QHP |
$703.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$492.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$703.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$597.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$492.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$703.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$527.52
|
| Rate for Payer: SOMOS Essential |
$527.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$703.36
|
|
|
PR DERMAL AUTOGRAFT TRUNK/ARM/LEG EA 100 CM/EA
|
Professional
|
Both
|
$389.69
|
|
|
Service Code
|
HCPCS 15131
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$234.68 |
| Rate for Payer: Cash Price |
$103.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$104.30
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$93.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$104.30
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.22
|
| Rate for Payer: Healthfirst Commercial |
$104.30
|
| Rate for Payer: Healthfirst Essential Plan |
$234.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$99.08
|
| Rate for Payer: Healthfirst QHP |
$104.30
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$73.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$104.30
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$88.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$73.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$104.30
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$78.22
|
| Rate for Payer: SOMOS Essential |
$78.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$104.30
|
|
|
PR DERMAL FILLER INJECTION(S)
|
Professional
|
Both
|
$282.52
|
|
|
Service Code
|
HCPCS G0429
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$173.21 |
| Rate for Payer: Cash Price |
$78.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$76.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$76.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.73
|
| Rate for Payer: Healthfirst Commercial |
$76.98
|
| Rate for Payer: Healthfirst Essential Plan |
$173.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.13
|
| Rate for Payer: Healthfirst QHP |
$76.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$53.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$65.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$53.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$76.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$57.73
|
| Rate for Payer: SOMOS Essential |
$57.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.98
|
|
|
PR DESCENDING THORACIC AORTA GRAFT W/WO BYPASS
|
Professional
|
Both
|
$12,129.39
|
|
|
Service Code
|
HCPCS 33875
|
| Min. Negotiated Rate |
$2,230.19 |
| Max. Negotiated Rate |
$7,168.45 |
| Rate for Payer: Cash Price |
$3,225.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,185.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,867.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,867.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,026.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,185.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,026.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,185.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,185.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,389.49
|
| Rate for Payer: Healthfirst Commercial |
$3,185.98
|
| Rate for Payer: Healthfirst Essential Plan |
$7,168.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,026.68
|
| Rate for Payer: Healthfirst QHP |
$3,185.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,230.19
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,185.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,708.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,230.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,185.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,389.49
|
| Rate for Payer: SOMOS Essential |
$2,389.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,185.98
|
|
|
PR DESTRUCTION BENIGN LESIONS 15/>
|
Professional
|
Both
|
$347.24
|
|
|
Service Code
|
HCPCS 17111
|
| Min. Negotiated Rate |
$67.93 |
| Max. Negotiated Rate |
$218.34 |
| Rate for Payer: Cash Price |
$96.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$97.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$87.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$92.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$97.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$92.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$97.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.78
|
| Rate for Payer: Healthfirst Commercial |
$97.04
|
| Rate for Payer: Healthfirst Essential Plan |
$218.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$92.19
|
| Rate for Payer: Healthfirst QHP |
$97.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$67.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$97.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$82.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$67.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$97.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72.78
|
| Rate for Payer: SOMOS Essential |
$72.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.04
|
|
|
PR DESTRUCTION BENIGN LESIONS UP TO 14
|
Professional
|
Both
|
$283.64
|
|
|
Service Code
|
HCPCS 17110
|
| Min. Negotiated Rate |
$55.62 |
| Max. Negotiated Rate |
$178.76 |
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$79.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$71.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$75.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$79.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$75.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$79.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.59
|
| Rate for Payer: Healthfirst Commercial |
$79.45
|
| Rate for Payer: Healthfirst Essential Plan |
$178.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$75.48
|
| Rate for Payer: Healthfirst QHP |
$79.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$55.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$79.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$67.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$55.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$79.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$59.59
|
| Rate for Payer: SOMOS Essential |
$59.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$79.45
|
|
|
PR DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM
|
Professional
|
Both
|
$1,166.45
|
|
|
Service Code
|
HCPCS 17106
|
| Min. Negotiated Rate |
$223.77 |
| Max. Negotiated Rate |
$719.26 |
| Rate for Payer: Cash Price |
$320.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$319.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$287.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$287.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$303.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$319.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$303.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$319.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$319.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.75
|
| Rate for Payer: Healthfirst Commercial |
$319.67
|
| Rate for Payer: Healthfirst Essential Plan |
$719.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$303.69
|
| Rate for Payer: Healthfirst QHP |
$319.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$223.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$319.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$271.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$223.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$319.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$239.75
|
| Rate for Payer: SOMOS Essential |
$239.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$319.67
|
|
|
PR DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY
|
Professional
|
Both
|
$651.42
|
|
|
Service Code
|
HCPCS 46930
|
| Min. Negotiated Rate |
$125.67 |
| Max. Negotiated Rate |
$403.94 |
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$179.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$161.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$161.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$179.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.65
|
| Rate for Payer: Healthfirst Commercial |
$179.53
|
| Rate for Payer: Healthfirst Essential Plan |
$403.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$170.55
|
| Rate for Payer: Healthfirst QHP |
$179.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$125.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$179.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$152.60
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$125.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$179.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$134.65
|
| Rate for Payer: SOMOS Essential |
$134.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$179.53
|
|
|
PR DESTRUCTION LESION CONJUNCTIVA
|
Professional
|
Both
|
$622.48
|
|
|
Service Code
|
HCPCS 68135
|
| Min. Negotiated Rate |
$118.52 |
| Max. Negotiated Rate |
$380.97 |
| Rate for Payer: Cash Price |
$169.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$169.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$152.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$152.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$169.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.99
|
| Rate for Payer: Healthfirst Commercial |
$169.32
|
| Rate for Payer: Healthfirst Essential Plan |
$380.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$160.85
|
| Rate for Payer: Healthfirst QHP |
$169.32
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$118.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$169.32
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$143.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$118.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$169.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$126.99
|
| Rate for Payer: SOMOS Essential |
$126.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.32
|
|
|
PR DESTRUCTION LESION LID MARGIN < 1 CM
|
Professional
|
Both
|
$549.08
|
|
|
Service Code
|
HCPCS 67850
|
| Min. Negotiated Rate |
$104.31 |
| Max. Negotiated Rate |
$335.30 |
| Rate for Payer: Cash Price |
$149.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$149.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$149.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$141.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.77
|
| Rate for Payer: Healthfirst Commercial |
$149.02
|
| Rate for Payer: Healthfirst Essential Plan |
$335.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$141.57
|
| Rate for Payer: Healthfirst QHP |
$149.02
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.02
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$126.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$149.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$111.77
|
| Rate for Payer: SOMOS Essential |
$111.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.02
|
|
|
PR DESTRUCTION LESIONS VULVA EXTENSIVE
|
Professional
|
Both
|
$927.96
|
|
|
Service Code
|
HCPCS 56515
|
| Min. Negotiated Rate |
$173.07 |
| Max. Negotiated Rate |
$556.31 |
| Rate for Payer: Cash Price |
$250.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$222.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$222.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$234.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$234.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$247.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.44
|
| Rate for Payer: Healthfirst Commercial |
$247.25
|
| Rate for Payer: Healthfirst Essential Plan |
$556.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$234.89
|
| Rate for Payer: Healthfirst QHP |
$247.25
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$173.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.25
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$210.16
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$173.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.25
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$185.44
|
| Rate for Payer: SOMOS Essential |
$185.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.25
|
|
|
PR DESTRUCTION LESIONS VULVA SIMPLE
|
Professional
|
Both
|
$582.54
|
|
|
Service Code
|
HCPCS 56501
|
| Min. Negotiated Rate |
$108.81 |
| Max. Negotiated Rate |
$349.74 |
| Rate for Payer: Cash Price |
$157.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$155.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$139.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.58
|
| Rate for Payer: Healthfirst Commercial |
$155.44
|
| Rate for Payer: Healthfirst Essential Plan |
$349.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.67
|
| Rate for Payer: Healthfirst QHP |
$155.44
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.81
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.44
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.44
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.58
|
| Rate for Payer: SOMOS Essential |
$116.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.44
|
|
|
PR DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$361.03
|
|
|
Service Code
|
HCPCS 17280
|
| Min. Negotiated Rate |
$70.36 |
| Max. Negotiated Rate |
$226.17 |
| Rate for Payer: Cash Price |
$100.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.39
|
| Rate for Payer: Healthfirst Commercial |
$100.52
|
| Rate for Payer: Healthfirst Essential Plan |
$226.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.49
|
| Rate for Payer: Healthfirst QHP |
$100.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.39
|
| Rate for Payer: SOMOS Essential |
$75.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.52
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$404.99
|
|
|
Service Code
|
HCPCS 17270
|
| Min. Negotiated Rate |
$77.73 |
| Max. Negotiated Rate |
$249.84 |
| Rate for Payer: Cash Price |
$110.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$99.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$99.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$105.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$105.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.28
|
| Rate for Payer: Healthfirst Commercial |
$111.04
|
| Rate for Payer: Healthfirst Essential Plan |
$249.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.49
|
| Rate for Payer: Healthfirst QHP |
$111.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$77.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$94.38
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$77.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.28
|
| Rate for Payer: SOMOS Essential |
$83.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.04
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM
|
Professional
|
Both
|
$443.52
|
|
|
Service Code
|
HCPCS 17271
|
| Min. Negotiated Rate |
$84.55 |
| Max. Negotiated Rate |
$271.75 |
| Rate for Payer: Cash Price |
$120.69
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$120.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$114.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$120.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$114.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.58
|
| Rate for Payer: Healthfirst Commercial |
$120.78
|
| Rate for Payer: Healthfirst Essential Plan |
$271.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$114.74
|
| Rate for Payer: Healthfirst QHP |
$120.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$84.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$120.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$102.66
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$84.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$120.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$90.58
|
| Rate for Payer: SOMOS Essential |
$90.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$120.78
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM
|
Professional
|
Both
|
$507.05
|
|
|
Service Code
|
HCPCS 17272
|
| Min. Negotiated Rate |
$96.78 |
| Max. Negotiated Rate |
$311.08 |
| Rate for Payer: Cash Price |
$139.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$138.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$124.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$124.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$138.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$138.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$138.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.69
|
| Rate for Payer: Healthfirst Commercial |
$138.26
|
| Rate for Payer: Healthfirst Essential Plan |
$311.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$131.35
|
| Rate for Payer: Healthfirst QHP |
$138.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$96.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$138.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$117.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$96.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$138.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$103.69
|
| Rate for Payer: SOMOS Essential |
$103.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$138.26
|
|
