|
PR PERCUTANEOUS TRANSCATHETER SEPTAL REDUCTION THER
|
Professional
|
Both
|
$3,242.65
|
|
|
Service Code
|
HCPCS 93583
|
| Min. Negotiated Rate |
$433.27 |
| Max. Negotiated Rate |
$1,921.88 |
| Rate for Payer: Amida Care Medicaid |
$433.27
|
| Rate for Payer: Cash Price |
$864.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$854.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$768.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$768.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$811.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$854.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$811.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$854.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$854.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$640.63
|
| Rate for Payer: Healthfirst Commercial |
$854.17
|
| Rate for Payer: Healthfirst Essential Plan |
$1,921.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$811.46
|
| Rate for Payer: Healthfirst QHP |
$854.17
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$597.92
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$854.17
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$726.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$597.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$854.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$640.63
|
| Rate for Payer: SOMOS Essential |
$640.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$854.17
|
|
|
PR PERCUTANEOUS TX MALAR AREA FRACTURE
|
Professional
|
Both
|
$1,426.64
|
|
|
Service Code
|
HCPCS 21355
|
| Min. Negotiated Rate |
$267.98 |
| Max. Negotiated Rate |
$861.37 |
| Rate for Payer: Cash Price |
$386.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$382.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$344.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$344.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$363.69
|
| Rate for Payer: Fidelis Medicare Advantage |
$382.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$363.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$382.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$382.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$287.12
|
| Rate for Payer: Healthfirst Commercial |
$382.83
|
| Rate for Payer: Healthfirst Essential Plan |
$861.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$363.69
|
| Rate for Payer: Healthfirst QHP |
$382.83
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$267.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$382.83
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$325.41
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$267.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$382.83
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$287.12
|
| Rate for Payer: SOMOS Essential |
$287.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$382.83
|
|
|
PR PERCUTANEOUS TX MANDIBULAR FX W/EXTERNAL FIXJ
|
Professional
|
Both
|
$1,996.26
|
|
|
Service Code
|
HCPCS 21452
|
| Min. Negotiated Rate |
$364.43 |
| Max. Negotiated Rate |
$1,171.37 |
| Rate for Payer: Cash Price |
$534.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$520.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$468.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$468.55
|
| Rate for Payer: Fidelis Essential Plan QHP |
$494.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$520.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$494.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$520.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$520.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$390.46
|
| Rate for Payer: Healthfirst Commercial |
$520.61
|
| Rate for Payer: Healthfirst Essential Plan |
$1,171.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$494.58
|
| Rate for Payer: Healthfirst QHP |
$520.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$364.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$520.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$442.52
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$364.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$520.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$390.46
|
| Rate for Payer: SOMOS Essential |
$390.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$520.61
|
|
|
PR PERCUTANEOUS TX NASOETHMOID COMPLEX FRACTURE
|
Professional
|
Both
|
$3,249.26
|
|
|
Service Code
|
HCPCS 21340
|
| Min. Negotiated Rate |
$612.35 |
| Max. Negotiated Rate |
$1,968.28 |
| Rate for Payer: Cash Price |
$881.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$874.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$787.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$787.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$831.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$874.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$831.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$874.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$874.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$656.09
|
| Rate for Payer: Healthfirst Commercial |
$874.79
|
| Rate for Payer: Healthfirst Essential Plan |
$1,968.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$831.05
|
| Rate for Payer: Healthfirst QHP |
$874.79
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$612.35
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$874.79
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$743.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$612.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$874.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$656.09
|
| Rate for Payer: SOMOS Essential |
$656.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$874.79
|
|
|
PR PERCUTAN TRANSCATH CLOSURE PAT DUCT ARTERIOSUS
|
Professional
|
Both
|
$2,903.46
|
|
|
Service Code
|
HCPCS 93582
|
| Min. Negotiated Rate |
$383.18 |
| Max. Negotiated Rate |
$1,714.75 |
| Rate for Payer: Amida Care Medicaid |
$383.18
|
| Rate for Payer: Cash Price |
$770.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$762.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$685.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$685.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$762.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$762.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$762.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$571.58
|
| Rate for Payer: Healthfirst Commercial |
$762.11
|
| Rate for Payer: Healthfirst Essential Plan |
$1,714.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$724.00
|
| Rate for Payer: Healthfirst QHP |
$762.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$533.48
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$762.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$647.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$533.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$762.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$571.58
|
| Rate for Payer: SOMOS Essential |
$571.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$762.11
|
|
|
PR PEREYRA PX W/ANTERIOR COLPORRHAPHY
|
Professional
|
Both
|
$3,465.77
|
|
|
Service Code
|
HCPCS 57289
|
| Min. Negotiated Rate |
$643.63 |
| Max. Negotiated Rate |
$2,068.81 |
| Rate for Payer: Cash Price |
$935.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$919.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$827.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$827.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$873.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$919.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$873.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$919.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$919.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$689.60
|
| Rate for Payer: Healthfirst Commercial |
$919.47
|
| Rate for Payer: Healthfirst Essential Plan |
$2,068.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$873.50
|
| Rate for Payer: Healthfirst QHP |
$919.47
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$643.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$919.47
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$781.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$643.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$919.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$689.60
|
| Rate for Payer: SOMOS Essential |
$689.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$919.47
|
|
|
PR PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED
|
Professional
|
Both
|
$1,026.80
|
|
|
Service Code
|
HCPCS 33016
|
| Min. Negotiated Rate |
$189.38 |
| Max. Negotiated Rate |
$608.72 |
| Rate for Payer: Cash Price |
$273.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$270.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$243.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$243.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$257.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$270.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$257.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$270.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.91
|
| Rate for Payer: Healthfirst Commercial |
$270.54
|
| Rate for Payer: Healthfirst Essential Plan |
$608.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$257.01
|
| Rate for Payer: Healthfirst QHP |
$270.54
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$189.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$270.54
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$229.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$189.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$270.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$202.91
|
| Rate for Payer: SOMOS Essential |
$202.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$270.54
|
|
|
PR PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY
|
Professional
|
Both
|
$3,668.88
|
|
|
Service Code
|
HCPCS 33020
|
| Min. Negotiated Rate |
$680.06 |
| Max. Negotiated Rate |
$2,185.90 |
| Rate for Payer: Cash Price |
$972.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$971.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$874.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$874.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$922.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$971.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$922.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$971.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$971.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$728.63
|
| Rate for Payer: Healthfirst Commercial |
$971.51
|
| Rate for Payer: Healthfirst Essential Plan |
$2,185.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$922.93
|
| Rate for Payer: Healthfirst QHP |
$971.51
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$680.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$971.51
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$825.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$680.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$971.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$728.63
|
| Rate for Payer: SOMOS Essential |
$728.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$971.51
|
|
|
PR PERI-IMPLANT CAPSULECTOMY BREAST COMPLETE
|
Professional
|
Both
|
$3,124.80
|
|
|
Service Code
|
HCPCS 19371
|
| Min. Negotiated Rate |
$589.10 |
| Max. Negotiated Rate |
$1,893.53 |
| Rate for Payer: Cash Price |
$841.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$841.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$757.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$757.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$799.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$841.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$799.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$841.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$841.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$631.18
|
| Rate for Payer: Healthfirst Commercial |
$841.57
|
| Rate for Payer: Healthfirst Essential Plan |
$1,893.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$799.49
|
| Rate for Payer: Healthfirst QHP |
$841.57
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$589.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$841.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$715.33
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$589.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$841.57
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$631.18
|
| Rate for Payer: SOMOS Essential |
$631.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$841.57
|
|
|
PR PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX
|
Professional
|
Both
|
$1,184.68
|
|
|
Service Code
|
HCPCS 56810
|
| Min. Negotiated Rate |
$220.53 |
| Max. Negotiated Rate |
$708.84 |
| Rate for Payer: Cash Price |
$322.13
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$315.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$283.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$283.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$315.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$315.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$315.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$236.28
|
| Rate for Payer: Healthfirst Commercial |
$315.04
|
| Rate for Payer: Healthfirst Essential Plan |
$708.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$299.29
|
| Rate for Payer: Healthfirst QHP |
$315.04
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$220.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$315.04
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$267.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$220.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$315.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$236.28
|
| Rate for Payer: SOMOS Essential |
$236.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$315.04
|
|
|
PR PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 99391
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$24.73 |
| Rate for Payer: Amida Care Medicaid |
$24.73
|
|
|
PR PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS
|
Professional
|
Both
|
$258.75
|
|
|
Service Code
|
HCPCS 99394
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Amida Care Medicaid |
$33.05
|
|
|
PR PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS
|
Professional
|
Both
|
$237.75
|
|
|
Service Code
|
HCPCS 99392
|
| Min. Negotiated Rate |
$28.89 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Amida Care Medicaid |
$28.89
|
|
|
PR PERIODIC PREVENTIVE MED EST PATIENT 18-39 YRS
|
Professional
|
Both
|
$263.25
|
|
|
Service Code
|
HCPCS 99395
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Amida Care Medicaid |
$33.05
|
|
|
PR PERIODIC PREVENTIVE MED EST PATIENT 40-64YRS
|
Professional
|
Both
|
$287.25
|
|
|
Service Code
|
HCPCS 99396
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$37.20 |
| Rate for Payer: Amida Care Medicaid |
$37.20
|
|
|
PR PERIODIC PREVENTIVE MED EST PATIENT 5-11YRS
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 99393
|
| Min. Negotiated Rate |
$28.89 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Amida Care Medicaid |
$28.89
|
|
|
PR PERIODIC PREVENTIVE MED EST PATIENT 65YRS& OLDER
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 99397
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$41.56 |
| Rate for Payer: Amida Care Medicaid |
$41.56
|
|
|
PR PERIORBITAL OSTEOTOMIES BONE GRAFTS EXTRACRANIAL
|
Professional
|
Both
|
$5,980.73
|
|
|
Service Code
|
HCPCS 21260
|
| Min. Negotiated Rate |
$1,119.01 |
| Max. Negotiated Rate |
$3,596.80 |
| Rate for Payer: Cash Price |
$1,608.56
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,598.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,438.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,438.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,518.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,598.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,518.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,598.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,598.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,198.93
|
| Rate for Payer: Healthfirst Commercial |
$1,598.58
|
| Rate for Payer: Healthfirst Essential Plan |
$3,596.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,518.65
|
| Rate for Payer: Healthfirst QHP |
$1,598.58
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,119.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,598.58
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,358.79
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,119.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,598.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,198.93
|
| Rate for Payer: SOMOS Essential |
$1,198.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,598.58
|
|
|
PR PERIORBITAL OSTEOTOMIES W/BONE GRAFTS ICRA & XTR
|
Professional
|
Both
|
$10,594.64
|
|
|
Service Code
|
HCPCS 21261
|
| Min. Negotiated Rate |
$1,981.86 |
| Max. Negotiated Rate |
$6,370.27 |
| Rate for Payer: Cash Price |
$2,846.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,831.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,548.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,548.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,689.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,831.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,689.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,831.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,831.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,123.42
|
| Rate for Payer: Healthfirst Commercial |
$2,831.23
|
| Rate for Payer: Healthfirst Essential Plan |
$6,370.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,689.67
|
| Rate for Payer: Healthfirst QHP |
$2,831.23
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,981.86
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,831.23
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,406.55
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,981.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,831.23
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,123.42
|
| Rate for Payer: SOMOS Essential |
$2,123.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,831.23
|
|
|
PR PERIORBITAL OSTEOTOMIES W/BONE GRAFTS W/FOREHEAD
|
Professional
|
Both
|
$9,797.97
|
|
|
Service Code
|
HCPCS 21263
|
| Min. Negotiated Rate |
$1,832.55 |
| Max. Negotiated Rate |
$5,890.34 |
| Rate for Payer: Cash Price |
$2,633.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,617.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,356.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,356.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,487.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,617.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,487.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,617.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,617.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,963.45
|
| Rate for Payer: Healthfirst Commercial |
$2,617.93
|
| Rate for Payer: Healthfirst Essential Plan |
$5,890.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,487.03
|
| Rate for Payer: Healthfirst QHP |
$2,617.93
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,832.55
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,617.93
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2,225.24
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,832.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,617.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,963.45
|
| Rate for Payer: SOMOS Essential |
$1,963.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,617.93
|
|
|
PR PERIPHERAL ARTERIAL DISEASE REHAB PER SESSION
|
Professional
|
Both
|
$63.11
|
|
|
Service Code
|
HCPCS 93668
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$38.95 |
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.98
|
| Rate for Payer: Healthfirst Commercial |
$17.31
|
| Rate for Payer: Healthfirst Essential Plan |
$38.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.44
|
| Rate for Payer: Healthfirst QHP |
$17.31
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$12.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.31
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$14.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$12.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.31
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$12.98
|
| Rate for Payer: SOMOS Essential |
$12.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.31
|
|
|
PR PERI-PX DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
Both
|
$195.41
|
|
|
Service Code
|
HCPCS 93286
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$114.23 |
| Rate for Payer: Amida Care Medicaid |
$21.56
|
| Rate for Payer: Cash Price |
$52.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$45.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$50.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.08
|
| Rate for Payer: Healthfirst Commercial |
$50.77
|
| Rate for Payer: Healthfirst Essential Plan |
$114.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48.23
|
| Rate for Payer: Healthfirst QHP |
$50.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$35.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$43.15
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$35.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$50.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$38.08
|
| Rate for Payer: SOMOS Essential |
$38.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.77
|
|
|
PR PERI-PX DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
Both
|
$57.58
|
|
|
Service Code
|
HCPCS 93286 26
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: Amida Care Medicaid |
$21.56
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.71
|
| Rate for Payer: Healthfirst Commercial |
$15.61
|
| Rate for Payer: Healthfirst Essential Plan |
$35.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.83
|
| Rate for Payer: Healthfirst QHP |
$15.61
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$10.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$15.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$13.27
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$10.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$11.71
|
| Rate for Payer: SOMOS Essential |
$11.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.61
|
|
|
PR PERI-PX DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
Both
|
$137.87
|
|
|
Service Code
|
HCPCS 93286 TC
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$79.11 |
| Rate for Payer: Amida Care Medicaid |
$21.56
|
| Rate for Payer: Cash Price |
$36.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$33.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.37
|
| Rate for Payer: Healthfirst Commercial |
$35.16
|
| Rate for Payer: Healthfirst Essential Plan |
$79.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.40
|
| Rate for Payer: Healthfirst QHP |
$35.16
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$24.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$35.16
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$29.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$24.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26.37
|
| Rate for Payer: SOMOS Essential |
$26.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.16
|
|
|
PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB
|
Professional
|
Both
|
$86.42
|
|
|
Service Code
|
HCPCS 93287 26
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Amida Care Medicaid |
$28.30
|
| Rate for Payer: Cash Price |
$23.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.33
|
| Rate for Payer: Healthfirst Commercial |
$23.11
|
| Rate for Payer: Healthfirst Essential Plan |
$52.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.95
|
| Rate for Payer: Healthfirst QHP |
$23.11
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.18
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$23.11
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$16.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.33
|
| Rate for Payer: SOMOS Essential |
$17.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.11
|
|
