|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM
|
Professional
|
Both
|
$573.34
|
|
|
Service Code
|
HCPCS 17273
|
| Min. Negotiated Rate |
$109.45 |
| Max. Negotiated Rate |
$351.81 |
| Rate for Payer: Cash Price |
$156.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$156.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$148.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$156.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.27
|
| Rate for Payer: Healthfirst Commercial |
$156.36
|
| Rate for Payer: Healthfirst Essential Plan |
$351.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$148.54
|
| Rate for Payer: Healthfirst QHP |
$156.36
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$156.36
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.36
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.27
|
| Rate for Payer: SOMOS Essential |
$117.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.36
|
|
|
PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM
|
Professional
|
Both
|
$700.67
|
|
|
Service Code
|
HCPCS 17274
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$431.35 |
| Rate for Payer: Cash Price |
$191.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$172.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$182.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$182.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.78
|
| Rate for Payer: Healthfirst Commercial |
$191.71
|
| Rate for Payer: Healthfirst Essential Plan |
$431.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$182.12
|
| Rate for Payer: Healthfirst QHP |
$191.71
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$134.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$191.71
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$162.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$134.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.71
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$143.78
|
| Rate for Payer: SOMOS Essential |
$143.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.71
|
|
|
PR DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<
|
Professional
|
Both
|
$297.12
|
|
|
Service Code
|
HCPCS 17260
|
| Min. Negotiated Rate |
$56.82 |
| Max. Negotiated Rate |
$182.63 |
| Rate for Payer: Cash Price |
$81.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$73.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.88
|
| Rate for Payer: Healthfirst Commercial |
$81.17
|
| Rate for Payer: Healthfirst Essential Plan |
$182.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77.11
|
| Rate for Payer: Healthfirst QHP |
$81.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$56.82
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$81.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$68.99
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$56.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$60.88
|
| Rate for Payer: SOMOS Essential |
$60.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.17
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM
|
Professional
|
Both
|
$496.48
|
|
|
Service Code
|
HCPCS 17281
|
| Min. Negotiated Rate |
$94.76 |
| Max. Negotiated Rate |
$304.58 |
| Rate for Payer: Cash Price |
$135.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$135.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$135.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.53
|
| Rate for Payer: Healthfirst Commercial |
$135.37
|
| Rate for Payer: Healthfirst Essential Plan |
$304.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$128.60
|
| Rate for Payer: Healthfirst QHP |
$135.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$135.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$115.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$135.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$101.53
|
| Rate for Payer: SOMOS Essential |
$101.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.37
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM
|
Professional
|
Both
|
$572.08
|
|
|
Service Code
|
HCPCS 17282
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$350.14 |
| Rate for Payer: Cash Price |
$156.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$155.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$140.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$140.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$147.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$155.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$147.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$155.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$155.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.72
|
| Rate for Payer: Healthfirst Commercial |
$155.62
|
| Rate for Payer: Healthfirst Essential Plan |
$350.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$147.84
|
| Rate for Payer: Healthfirst QHP |
$155.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$108.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$155.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$132.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$108.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$155.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$116.72
|
| Rate for Payer: SOMOS Essential |
$116.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$155.62
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM
|
Professional
|
Both
|
$709.80
|
|
|
Service Code
|
HCPCS 17283
|
| Min. Negotiated Rate |
$135.95 |
| Max. Negotiated Rate |
$436.97 |
| Rate for Payer: Cash Price |
$195.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$194.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$174.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$184.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$194.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$184.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$194.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$194.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$145.66
|
| Rate for Payer: Healthfirst Commercial |
$194.21
|
| Rate for Payer: Healthfirst Essential Plan |
$436.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$184.50
|
| Rate for Payer: Healthfirst QHP |
$194.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$135.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$194.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$165.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$135.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$194.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$145.66
|
| Rate for Payer: SOMOS Essential |
$145.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$194.21
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM
|
Professional
|
Both
|
$831.64
|
|
|
Service Code
|
HCPCS 17284
|
| Min. Negotiated Rate |
$158.72 |
| Max. Negotiated Rate |
$510.17 |
| Rate for Payer: Cash Price |
$226.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$226.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$204.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$204.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$226.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$215.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$226.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.06
|
| Rate for Payer: Healthfirst Commercial |
$226.74
|
| Rate for Payer: Healthfirst Essential Plan |
$510.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$215.40
|
| Rate for Payer: Healthfirst QHP |
$226.74
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$158.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$226.74
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$192.73
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$158.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$226.74
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$170.06
|
| Rate for Payer: SOMOS Essential |
$170.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$226.74
|
|
|
PR DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM
|
Professional
|
Both
|
$1,119.65
|
|
|
Service Code
|
HCPCS 17286
|
| Min. Negotiated Rate |
$216.89 |
| Max. Negotiated Rate |
$697.14 |
| Rate for Payer: Cash Price |
$307.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$309.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$278.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$278.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$309.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$309.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$309.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$232.38
|
| Rate for Payer: Healthfirst Commercial |
$309.84
|
| Rate for Payer: Healthfirst Essential Plan |
$697.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$294.35
|
| Rate for Payer: Healthfirst QHP |
$309.84
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$216.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$309.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$263.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$216.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$309.84
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$232.38
|
| Rate for Payer: SOMOS Essential |
$232.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$309.84
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$362.46
|
|
|
Service Code
|
HCPCS 17261
|
| Min. Negotiated Rate |
$70.64 |
| Max. Negotiated Rate |
$227.05 |
| Rate for Payer: Cash Price |
$100.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$100.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$90.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$90.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$100.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.68
|
| Rate for Payer: Healthfirst Commercial |
$100.91
|
| Rate for Payer: Healthfirst Essential Plan |
$227.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.86
|
| Rate for Payer: Healthfirst QHP |
$100.91
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$70.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$100.91
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$85.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$70.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$100.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$75.68
|
| Rate for Payer: SOMOS Essential |
$75.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.91
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM
|
Professional
|
Both
|
$464.73
|
|
|
Service Code
|
HCPCS 17262
|
| Min. Negotiated Rate |
$88.35 |
| Max. Negotiated Rate |
$283.97 |
| Rate for Payer: Cash Price |
$126.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$126.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$113.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$113.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$119.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$126.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$119.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.66
|
| Rate for Payer: Healthfirst Commercial |
$126.21
|
| Rate for Payer: Healthfirst Essential Plan |
$283.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$119.90
|
| Rate for Payer: Healthfirst QHP |
$126.21
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$88.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$126.21
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$107.28
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$88.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$126.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$94.66
|
| Rate for Payer: SOMOS Essential |
$94.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$126.21
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
HCPCS 17263
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$313.51 |
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$139.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$125.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$132.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$139.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$132.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$139.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.50
|
| Rate for Payer: Healthfirst Commercial |
$139.34
|
| Rate for Payer: Healthfirst Essential Plan |
$313.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$132.37
|
| Rate for Payer: Healthfirst QHP |
$139.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$139.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$118.44
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$97.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$139.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$104.50
|
| Rate for Payer: SOMOS Essential |
$104.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$139.34
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM
|
Professional
|
Both
|
$544.04
|
|
|
Service Code
|
HCPCS 17264
|
| Min. Negotiated Rate |
$104.89 |
| Max. Negotiated Rate |
$337.16 |
| Rate for Payer: Cash Price |
$149.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$149.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$134.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$149.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.39
|
| Rate for Payer: Healthfirst Commercial |
$149.85
|
| Rate for Payer: Healthfirst Essential Plan |
$337.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.36
|
| Rate for Payer: Healthfirst QHP |
$149.85
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$104.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$149.85
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$104.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$149.85
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.39
|
| Rate for Payer: SOMOS Essential |
$112.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$149.85
|
|
|
PR DESTRUCTION MAL LESION TRUNK/ARM/LEG > 4.0 CM
|
Professional
|
Both
|
$642.32
|
|
|
Service Code
|
HCPCS 17266
|
| Min. Negotiated Rate |
$122.52 |
| Max. Negotiated Rate |
$393.82 |
| Rate for Payer: Cash Price |
$175.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$175.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$157.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$157.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$166.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$175.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$166.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.27
|
| Rate for Payer: Healthfirst Commercial |
$175.03
|
| Rate for Payer: Healthfirst Essential Plan |
$393.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$166.28
|
| Rate for Payer: Healthfirst QHP |
$175.03
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$122.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$175.03
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$148.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$122.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$175.03
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$131.27
|
| Rate for Payer: SOMOS Essential |
$131.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.03
|
|
|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Professional
|
Both
|
$603.19
|
|
|
Service Code
|
HCPCS 64624
|
| Min. Negotiated Rate |
$115.89 |
| Max. Negotiated Rate |
$372.49 |
| Rate for Payer: Cash Price |
$165.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$165.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$149.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$149.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$157.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$165.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$157.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.16
|
| Rate for Payer: Healthfirst Commercial |
$165.55
|
| Rate for Payer: Healthfirst Essential Plan |
$372.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$157.27
|
| Rate for Payer: Healthfirst QHP |
$165.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$115.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$140.72
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$115.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$165.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$124.16
|
| Rate for Payer: SOMOS Essential |
$124.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$165.55
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 15/>
|
Professional
|
Both
|
$420.81
|
|
|
Service Code
|
HCPCS 17004
|
| Min. Negotiated Rate |
$79.36 |
| Max. Negotiated Rate |
$255.08 |
| Rate for Payer: Cash Price |
$113.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$102.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$102.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$107.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$107.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.03
|
| Rate for Payer: Healthfirst Commercial |
$113.37
|
| Rate for Payer: Healthfirst Essential Plan |
$255.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$107.70
|
| Rate for Payer: Healthfirst QHP |
$113.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$79.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$113.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$96.36
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$79.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$85.03
|
| Rate for Payer: SOMOS Essential |
$85.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.37
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 1ST
|
Professional
|
Both
|
$230.83
|
|
|
Service Code
|
HCPCS 17000
|
| Min. Negotiated Rate |
$44.04 |
| Max. Negotiated Rate |
$141.57 |
| Rate for Payer: Cash Price |
$63.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$56.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$56.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.19
|
| Rate for Payer: Healthfirst Commercial |
$62.92
|
| Rate for Payer: Healthfirst Essential Plan |
$141.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$59.77
|
| Rate for Payer: Healthfirst QHP |
$62.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$44.04
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$62.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$53.48
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$44.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.19
|
| Rate for Payer: SOMOS Essential |
$47.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.92
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Professional
|
Both
|
$7.88
|
|
|
Service Code
|
HCPCS 17003
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$4.84 |
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.61
|
| Rate for Payer: Healthfirst Commercial |
$2.15
|
| Rate for Payer: Healthfirst Essential Plan |
$4.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.04
|
| Rate for Payer: Healthfirst QHP |
$2.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.83
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.61
|
| Rate for Payer: SOMOS Essential |
$1.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.15
|
|
|
PR DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH
|
Professional
|
Both
|
$3,005.56
|
|
|
Service Code
|
HCPCS 45190
|
| Min. Negotiated Rate |
$564.95 |
| Max. Negotiated Rate |
$1,815.91 |
| Rate for Payer: Cash Price |
$814.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$807.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$726.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$726.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$766.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$807.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$766.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$807.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$807.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$605.30
|
| Rate for Payer: Healthfirst Commercial |
$807.07
|
| Rate for Payer: Healthfirst Essential Plan |
$1,815.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$766.72
|
| Rate for Payer: Healthfirst QHP |
$807.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$564.95
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$807.07
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$686.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$564.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$807.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$605.30
|
| Rate for Payer: SOMOS Essential |
$605.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$807.07
|
|
|
PR DESTRUCTION RETINOPATHY CRYOTHERAPY DIATHERMY
|
Professional
|
Both
|
$1,044.12
|
|
|
Service Code
|
HCPCS 67227
|
| Min. Negotiated Rate |
$199.22 |
| Max. Negotiated Rate |
$640.35 |
| Rate for Payer: Cash Price |
$287.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$284.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$256.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$256.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$270.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$284.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$270.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$284.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.45
|
| Rate for Payer: Healthfirst Commercial |
$284.60
|
| Rate for Payer: Healthfirst Essential Plan |
$640.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$270.37
|
| Rate for Payer: Healthfirst QHP |
$284.60
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$199.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$284.60
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$241.91
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$199.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$284.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$213.45
|
| Rate for Payer: SOMOS Essential |
$213.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$284.60
|
|
|
PR DESTRUCTION VAGINAL LESIONS EXTENSIVE
|
Professional
|
Both
|
$811.62
|
|
|
Service Code
|
HCPCS 57065
|
| Min. Negotiated Rate |
$151.38 |
| Max. Negotiated Rate |
$486.58 |
| Rate for Payer: Cash Price |
$219.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$216.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$194.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$194.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$216.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$216.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$216.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.19
|
| Rate for Payer: Healthfirst Commercial |
$216.26
|
| Rate for Payer: Healthfirst Essential Plan |
$486.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$205.45
|
| Rate for Payer: Healthfirst QHP |
$216.26
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$151.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$216.26
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$183.82
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$151.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$216.26
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$162.19
|
| Rate for Payer: SOMOS Essential |
$162.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$216.26
|
|
|
PR DESTRUCTION VAGINAL LESIONS SIMPLE
|
Professional
|
Both
|
$504.77
|
|
|
Service Code
|
HCPCS 57061
|
| Min. Negotiated Rate |
$94.23 |
| Max. Negotiated Rate |
$302.89 |
| Rate for Payer: Cash Price |
$136.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$134.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.16
|
| Rate for Payer: Fidelis Essential Plan QHP |
$127.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$134.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$127.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.97
|
| Rate for Payer: Healthfirst Commercial |
$134.62
|
| Rate for Payer: Healthfirst Essential Plan |
$302.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.89
|
| Rate for Payer: Healthfirst QHP |
$134.62
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$94.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$134.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$114.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$94.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$134.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$100.97
|
| Rate for Payer: SOMOS Essential |
$100.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$134.62
|
|
|
PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 96110
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$15.76 |
| Rate for Payer: Amida Care Medicaid |
$15.76
|
|
|
PR DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$502.71
|
|
|
Service Code
|
HCPCS 96112
|
| Min. Negotiated Rate |
$68.41 |
| Max. Negotiated Rate |
$299.27 |
| Rate for Payer: Amida Care Medicaid |
$68.41
|
| Rate for Payer: Cash Price |
$137.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$133.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$119.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$119.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.36
|
| Rate for Payer: Fidelis Medicare Advantage |
$133.01
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$133.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$133.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.76
|
| Rate for Payer: Healthfirst Commercial |
$133.01
|
| Rate for Payer: Healthfirst Essential Plan |
$299.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$126.36
|
| Rate for Payer: Healthfirst QHP |
$133.01
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$93.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$133.01
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$113.06
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$93.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$133.01
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$99.76
|
| Rate for Payer: SOMOS Essential |
$99.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$133.01
|
|
|
PR DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN
|
Professional
|
Both
|
$224.95
|
|
|
Service Code
|
HCPCS 96113
|
| Min. Negotiated Rate |
$31.30 |
| Max. Negotiated Rate |
$120.80 |
| Rate for Payer: Amida Care Medicaid |
$31.30
|
| Rate for Payer: Cash Price |
$62.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$48.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$48.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$51.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$53.69
|
| Rate for Payer: Fidelis Qualified Health Plan |
$51.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.27
|
| Rate for Payer: Healthfirst Commercial |
$53.69
|
| Rate for Payer: Healthfirst Essential Plan |
$120.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.01
|
| Rate for Payer: Healthfirst QHP |
$53.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$37.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$53.69
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$45.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$37.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$53.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.27
|
| Rate for Payer: SOMOS Essential |
$40.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$53.69
|
|
|
PR DEVLOPMENT TEST INTERPT&REP
|
Professional
|
Both
|
$47.29
|
|
|
Service Code
|
HCPCS G0451
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$31.09 |
| Rate for Payer: Cash Price |
$13.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.37
|
| Rate for Payer: Healthfirst Commercial |
$13.82
|
| Rate for Payer: Healthfirst Essential Plan |
$31.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.13
|
| Rate for Payer: Healthfirst QHP |
$13.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$13.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$11.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$10.37
|
| Rate for Payer: SOMOS Essential |
$10.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.82
|
|
