|
PR DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS
|
Professional
|
Both
|
$5,077.17
|
|
|
Service Code
|
HCPCS 36838
|
| Min. Negotiated Rate |
$929.58 |
| Max. Negotiated Rate |
$2,987.93 |
| Rate for Payer: Cash Price |
$1,342.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,327.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,195.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,195.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,261.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,327.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,261.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,327.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,327.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$995.98
|
| Rate for Payer: Healthfirst Commercial |
$1,327.97
|
| Rate for Payer: Healthfirst Essential Plan |
$2,987.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,261.57
|
| Rate for Payer: Healthfirst QHP |
$1,327.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$929.58
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,327.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,128.77
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$929.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,327.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$995.98
|
| Rate for Payer: SOMOS Essential |
$995.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,327.97
|
|
|
PR DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM
|
Professional
|
Both
|
$1,512.42
|
|
|
Service Code
|
HCPCS 17107
|
| Min. Negotiated Rate |
$291.14 |
| Max. Negotiated Rate |
$935.82 |
| Rate for Payer: Cash Price |
$415.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$374.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$374.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$395.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$395.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$415.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$311.94
|
| Rate for Payer: Healthfirst Commercial |
$415.92
|
| Rate for Payer: Healthfirst Essential Plan |
$935.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$395.12
|
| Rate for Payer: Healthfirst QHP |
$415.92
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$291.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$415.92
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$353.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$291.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.92
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$311.94
|
| Rate for Payer: SOMOS Essential |
$311.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.92
|
|
|
PR DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM
|
Professional
|
Both
|
$2,235.49
|
|
|
Service Code
|
HCPCS 17108
|
| Min. Negotiated Rate |
$427.67 |
| Max. Negotiated Rate |
$1,374.66 |
| Rate for Payer: Cash Price |
$614.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$610.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$549.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$549.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$580.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$610.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$580.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$610.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$610.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$458.22
|
| Rate for Payer: Healthfirst Commercial |
$610.96
|
| Rate for Payer: Healthfirst Essential Plan |
$1,374.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$580.41
|
| Rate for Payer: Healthfirst QHP |
$610.96
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$427.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$610.96
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$519.32
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$427.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$610.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$458.22
|
| Rate for Payer: SOMOS Essential |
$458.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$610.96
|
|
|
PR DSTRJ CYST/LESION IRIS/CILIARY BODY
|
Professional
|
Both
|
$1,980.37
|
|
|
Service Code
|
HCPCS 66770
|
| Min. Negotiated Rate |
$378.94 |
| Max. Negotiated Rate |
$1,218.04 |
| Rate for Payer: Cash Price |
$546.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$541.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$487.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$487.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$514.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$541.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$514.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$541.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$541.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$406.01
|
| Rate for Payer: Healthfirst Commercial |
$541.35
|
| Rate for Payer: Healthfirst Essential Plan |
$1,218.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$514.28
|
| Rate for Payer: Healthfirst QHP |
$541.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$378.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$541.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$460.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$378.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$541.35
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$406.01
|
| Rate for Payer: SOMOS Essential |
$406.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$541.35
|
|
|
PR DSTRJ LESION ANUS EXTENSIVE
|
Professional
|
Both
|
$778.68
|
|
|
Service Code
|
HCPCS 46924
|
| Min. Negotiated Rate |
$148.86 |
| Max. Negotiated Rate |
$478.49 |
| Rate for Payer: Cash Price |
$212.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$212.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$191.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$191.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$202.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$212.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$202.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$159.50
|
| Rate for Payer: Healthfirst Commercial |
$212.66
|
| Rate for Payer: Healthfirst Essential Plan |
$478.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$202.03
|
| Rate for Payer: Healthfirst QHP |
$212.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$148.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$212.66
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$180.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$148.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$212.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$159.50
|
| Rate for Payer: SOMOS Essential |
$159.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$212.66
|
|
|
PR DSTRJ LESION ANUS SIMPLE CHEMICAL
|
Professional
|
Both
|
$587.79
|
|
|
Service Code
|
HCPCS 46900
|
| Min. Negotiated Rate |
$112.63 |
| Max. Negotiated Rate |
$362.02 |
| Rate for Payer: Cash Price |
$160.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$160.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$144.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$144.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$152.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$160.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$152.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.67
|
| Rate for Payer: Healthfirst Commercial |
$160.90
|
| Rate for Payer: Healthfirst Essential Plan |
$362.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$152.85
|
| Rate for Payer: Healthfirst QHP |
$160.90
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$112.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$160.90
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$136.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$112.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$160.90
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$120.67
|
| Rate for Payer: SOMOS Essential |
$120.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$160.90
|
|
|
PR DSTRJ LESION ANUS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$597.28
|
|
|
Service Code
|
HCPCS 46916
|
| Min. Negotiated Rate |
$114.38 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Cash Price |
$164.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$163.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$147.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$155.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$163.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$155.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$163.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.55
|
| Rate for Payer: Healthfirst Commercial |
$163.40
|
| Rate for Payer: Healthfirst Essential Plan |
$367.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.23
|
| Rate for Payer: Healthfirst QHP |
$163.40
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$163.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$138.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$163.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$122.55
|
| Rate for Payer: SOMOS Essential |
$122.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.40
|
|
|
PR DSTRJ LESION ANUS SIMPLE LASER SURG
|
Professional
|
Both
|
$555.77
|
|
|
Service Code
|
HCPCS 46917
|
| Min. Negotiated Rate |
$105.34 |
| Max. Negotiated Rate |
$338.60 |
| Rate for Payer: Cash Price |
$151.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$150.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$135.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$142.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$150.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.87
|
| Rate for Payer: Healthfirst Commercial |
$150.49
|
| Rate for Payer: Healthfirst Essential Plan |
$338.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$142.97
|
| Rate for Payer: Healthfirst QHP |
$150.49
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$105.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$150.49
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$127.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$105.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$112.87
|
| Rate for Payer: SOMOS Essential |
$112.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150.49
|
|
|
PR DSTRJ LESION ANUS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$603.79
|
|
|
Service Code
|
HCPCS 46922
|
| Min. Negotiated Rate |
$114.08 |
| Max. Negotiated Rate |
$366.68 |
| Rate for Payer: Cash Price |
$163.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$162.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$146.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$146.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$154.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$162.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$154.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$162.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$162.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.23
|
| Rate for Payer: Healthfirst Commercial |
$162.97
|
| Rate for Payer: Healthfirst Essential Plan |
$366.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.82
|
| Rate for Payer: Healthfirst QHP |
$162.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$114.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$162.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$138.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$114.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$162.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$122.23
|
| Rate for Payer: SOMOS Essential |
$122.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$162.97
|
|
|
PR DSTRJ LESION ANUS SMPL ELTRDSICCATION
|
Professional
|
Both
|
$581.49
|
|
|
Service Code
|
HCPCS 46910
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$353.45 |
| Rate for Payer: Cash Price |
$159.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$149.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$149.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.82
|
| Rate for Payer: Healthfirst Commercial |
$157.09
|
| Rate for Payer: Healthfirst Essential Plan |
$353.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$149.24
|
| Rate for Payer: Healthfirst QHP |
$157.09
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$109.96
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$157.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$133.53
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$109.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.09
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$117.82
|
| Rate for Payer: SOMOS Essential |
$117.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.09
|
|
|
PR DSTRJ LESION CHOROID PC 1/> SESS
|
Professional
|
Both
|
$2,051.88
|
|
|
Service Code
|
HCPCS 67220
|
| Min. Negotiated Rate |
$390.74 |
| Max. Negotiated Rate |
$1,255.95 |
| Rate for Payer: Cash Price |
$565.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$558.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$502.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$502.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$530.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$558.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$530.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$558.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$558.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$418.65
|
| Rate for Payer: Healthfirst Commercial |
$558.20
|
| Rate for Payer: Healthfirst Essential Plan |
$1,255.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$530.29
|
| Rate for Payer: Healthfirst QHP |
$558.20
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$390.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$558.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$474.47
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$390.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$558.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$418.65
|
| Rate for Payer: SOMOS Essential |
$418.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$558.20
|
|
|
PR DSTRJ LESION CHOROID PDT 2ND EYE 1 SESSION
|
Professional
|
Both
|
$112.95
|
|
|
Service Code
|
HCPCS 67225
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$68.20 |
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$27.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$28.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$30.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.73
|
| Rate for Payer: Healthfirst Commercial |
$30.31
|
| Rate for Payer: Healthfirst Essential Plan |
$68.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.79
|
| Rate for Payer: Healthfirst QHP |
$30.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$21.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$30.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$25.76
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$21.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.73
|
| Rate for Payer: SOMOS Essential |
$22.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.31
|
|
|
PR DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY
|
Professional
|
Both
|
$848.26
|
|
|
Service Code
|
HCPCS 67221
|
| Min. Negotiated Rate |
$161.45 |
| Max. Negotiated Rate |
$518.94 |
| Rate for Payer: Cash Price |
$232.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$207.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$207.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$230.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$172.98
|
| Rate for Payer: Healthfirst Commercial |
$230.64
|
| Rate for Payer: Healthfirst Essential Plan |
$518.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$219.11
|
| Rate for Payer: Healthfirst QHP |
$230.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$161.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.64
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$196.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$161.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.64
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$172.98
|
| Rate for Payer: SOMOS Essential |
$172.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.64
|
|
|
PR DSTRJ LESION CRYOTHER PHOTO/THERMOCAUTZATION
|
Professional
|
Both
|
$1,336.62
|
|
|
Service Code
|
HCPCS 65450
|
| Min. Negotiated Rate |
$257.46 |
| Max. Negotiated Rate |
$827.55 |
| Rate for Payer: Cash Price |
$370.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$367.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$331.02
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$331.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$349.41
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$349.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$367.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$367.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$275.85
|
| Rate for Payer: Healthfirst Commercial |
$367.80
|
| Rate for Payer: Healthfirst Essential Plan |
$827.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$349.41
|
| Rate for Payer: Healthfirst QHP |
$367.80
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$257.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$367.80
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$312.63
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$257.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$367.80
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$275.85
|
| Rate for Payer: SOMOS Essential |
$275.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$367.80
|
|
|
PR DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM
|
Professional
|
Both
|
$616.35
|
|
|
Service Code
|
HCPCS 42160
|
| Min. Negotiated Rate |
$113.09 |
| Max. Negotiated Rate |
$363.51 |
| Rate for Payer: Cash Price |
$164.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$161.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$145.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$145.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$153.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$161.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$153.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$121.17
|
| Rate for Payer: Healthfirst Commercial |
$161.56
|
| Rate for Payer: Healthfirst Essential Plan |
$363.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.48
|
| Rate for Payer: Healthfirst QHP |
$161.56
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$113.09
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$161.56
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$137.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$113.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$161.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$121.17
|
| Rate for Payer: SOMOS Essential |
$121.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.56
|
|
|
PR DSTRJ LESION PENIS EXTENSIVE
|
Professional
|
Both
|
$721.18
|
|
|
Service Code
|
HCPCS 54065
|
| Min. Negotiated Rate |
$139.99 |
| Max. Negotiated Rate |
$449.95 |
| Rate for Payer: Cash Price |
$198.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$199.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$179.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$179.98
|
| Rate for Payer: Fidelis Essential Plan QHP |
$189.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$199.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$189.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$199.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$199.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.99
|
| Rate for Payer: Healthfirst Commercial |
$199.98
|
| Rate for Payer: Healthfirst Essential Plan |
$449.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$189.98
|
| Rate for Payer: Healthfirst QHP |
$199.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$139.99
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$199.98
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$169.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$139.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$199.98
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$149.99
|
| Rate for Payer: SOMOS Essential |
$149.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$199.98
|
|
|
PR DSTRJ LESION PENIS SIMPLE CHEMICAL
|
Professional
|
Both
|
$456.79
|
|
|
Service Code
|
HCPCS 54050
|
| Min. Negotiated Rate |
$87.48 |
| Max. Negotiated Rate |
$281.18 |
| Rate for Payer: Cash Price |
$124.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$124.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$112.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$112.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$118.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$124.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$118.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.73
|
| Rate for Payer: Healthfirst Commercial |
$124.97
|
| Rate for Payer: Healthfirst Essential Plan |
$281.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$118.72
|
| Rate for Payer: Healthfirst QHP |
$124.97
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$87.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$124.97
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$106.22
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$87.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$124.97
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.73
|
| Rate for Payer: SOMOS Essential |
$93.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$124.97
|
|
|
PR DSTRJ LESION PENIS SIMPLE CRYOSURGERY
|
Professional
|
Both
|
$471.56
|
|
|
Service Code
|
HCPCS 54056
|
| Min. Negotiated Rate |
$91.94 |
| Max. Negotiated Rate |
$295.51 |
| Rate for Payer: Cash Price |
$130.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$131.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$118.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$118.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$124.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$131.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$124.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.50
|
| Rate for Payer: Healthfirst Commercial |
$131.34
|
| Rate for Payer: Healthfirst Essential Plan |
$295.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$124.77
|
| Rate for Payer: Healthfirst QHP |
$131.34
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$91.94
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$131.34
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$111.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$91.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$131.34
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$98.50
|
| Rate for Payer: SOMOS Essential |
$98.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$131.34
|
|
|
PR DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION
|
Professional
|
Both
|
$410.06
|
|
|
Service Code
|
HCPCS 54055
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$253.12 |
| Rate for Payer: Cash Price |
$111.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$101.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.38
|
| Rate for Payer: Healthfirst Commercial |
$112.50
|
| Rate for Payer: Healthfirst Essential Plan |
$253.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.88
|
| Rate for Payer: Healthfirst QHP |
$112.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.75
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.62
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.38
|
| Rate for Payer: SOMOS Essential |
$84.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.50
|
|
|
PR DSTRJ LESION PENIS SIMPLE LASER
|
Professional
|
Both
|
$417.97
|
|
|
Service Code
|
HCPCS 54057
|
| Min. Negotiated Rate |
$78.25 |
| Max. Negotiated Rate |
$251.50 |
| Rate for Payer: Cash Price |
$114.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$111.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$106.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$111.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$106.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.83
|
| Rate for Payer: Healthfirst Commercial |
$111.78
|
| Rate for Payer: Healthfirst Essential Plan |
$251.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$106.19
|
| Rate for Payer: Healthfirst QHP |
$111.78
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$78.25
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$111.78
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$95.01
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$78.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$111.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$83.83
|
| Rate for Payer: SOMOS Essential |
$83.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$111.78
|
|
|
PR DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$552.41
|
|
|
Service Code
|
HCPCS 54060
|
| Min. Negotiated Rate |
$106.76 |
| Max. Negotiated Rate |
$343.17 |
| Rate for Payer: Cash Price |
$152.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$137.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$137.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$144.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$144.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$152.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.39
|
| Rate for Payer: Healthfirst Commercial |
$152.52
|
| Rate for Payer: Healthfirst Essential Plan |
$343.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$144.89
|
| Rate for Payer: Healthfirst QHP |
$152.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.76
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$152.52
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$129.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$106.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$114.39
|
| Rate for Payer: SOMOS Essential |
$114.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.52
|
|
|
PR DSTRJ LESION RETINA 1/> SESS RADJ IMPLTJ
|
Professional
|
Both
|
$5,703.81
|
|
|
Service Code
|
HCPCS 67218
|
| Min. Negotiated Rate |
$1,079.11 |
| Max. Negotiated Rate |
$3,468.58 |
| Rate for Payer: Cash Price |
$1,563.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,541.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,387.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,387.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,464.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,541.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,464.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,541.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,541.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,156.19
|
| Rate for Payer: Healthfirst Commercial |
$1,541.59
|
| Rate for Payer: Healthfirst Essential Plan |
$3,468.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,464.51
|
| Rate for Payer: Healthfirst QHP |
$1,541.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,079.11
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,541.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,310.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,079.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,541.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,156.19
|
| Rate for Payer: SOMOS Essential |
$1,156.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,541.59
|
|
|
PR DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS
|
Professional
|
Both
|
$709.28
|
|
|
Service Code
|
HCPCS 40820
|
| Min. Negotiated Rate |
$133.36 |
| Max. Negotiated Rate |
$428.65 |
| Rate for Payer: Cash Price |
$194.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$190.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$171.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$171.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$180.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$190.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$180.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.88
|
| Rate for Payer: Healthfirst Commercial |
$190.51
|
| Rate for Payer: Healthfirst Essential Plan |
$428.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$180.98
|
| Rate for Payer: Healthfirst QHP |
$190.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$133.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$190.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$161.93
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$133.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$190.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$142.88
|
| Rate for Payer: SOMOS Essential |
$142.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$190.51
|
|
|
PR DSTRJ LOCLZD LESION RETINA 1/> SESS CRTX DTHRM
|
Professional
|
Both
|
$2,368.91
|
|
|
Service Code
|
HCPCS 67208
|
| Min. Negotiated Rate |
$451.17 |
| Max. Negotiated Rate |
$1,450.19 |
| Rate for Payer: Cash Price |
$653.01
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$644.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$580.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$580.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$612.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$644.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$612.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$644.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$644.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$483.40
|
| Rate for Payer: Healthfirst Commercial |
$644.53
|
| Rate for Payer: Healthfirst Essential Plan |
$1,450.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$612.30
|
| Rate for Payer: Healthfirst QHP |
$644.53
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$451.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$644.53
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$547.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$451.17
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$644.53
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$483.40
|
| Rate for Payer: SOMOS Essential |
$483.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$644.53
|
|
|
PR DSTRJ LOCLZD LESION RETINA 1/> SESS PC
|
Professional
|
Both
|
$2,054.64
|
|
|
Service Code
|
HCPCS 67210
|
| Min. Negotiated Rate |
$390.63 |
| Max. Negotiated Rate |
$1,255.59 |
| Rate for Payer: Cash Price |
$565.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$558.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$502.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$502.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$530.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$558.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$530.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$558.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$558.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$418.53
|
| Rate for Payer: Healthfirst Commercial |
$558.04
|
| Rate for Payer: Healthfirst Essential Plan |
$1,255.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$530.14
|
| Rate for Payer: Healthfirst QHP |
$558.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$390.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$558.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$474.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$390.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$558.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$418.53
|
| Rate for Payer: SOMOS Essential |
$418.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$558.04
|
|
