|
PROPYLTHIOURACIL 50 MG PO TABS
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 6725365110
|
| Hospital Charge Code |
6725365110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
|
|
PROPYLTHIOURACIL 50 MG PO TABS
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 0228234810
|
| Hospital Charge Code |
0228234810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Brighton Health Commercial |
$0.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.61
|
| Rate for Payer: EmblemHealth Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
|
|
PROPYLTHIOURACIL 50 MG PO TABS
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 6725365110
|
| Hospital Charge Code |
6725365110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Brighton Health Commercial |
$0.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.61
|
| Rate for Payer: EmblemHealth Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
|
|
PROPYLTHIOURACIL 50 MG PO TABS
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 0228234810
|
| Hospital Charge Code |
0228234810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
|
|
PROPYLTHIOURACIL 50 MG PO TABS
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 0480924201
|
| Hospital Charge Code |
0480924201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$0.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
|
|
PROPYLTHIOURACIL 50 MG PO TABS
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 0480924201
|
| Hospital Charge Code |
0480924201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Brighton Health Commercial |
$0.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.61
|
| Rate for Payer: EmblemHealth Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
|
|
PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST
|
Professional
|
Both
|
$349.20
|
|
|
Service Code
|
HCPCS 95933
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$205.88 |
| Rate for Payer: Amida Care Medicaid |
$51.30
|
| Rate for Payer: Cash Price |
$95.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$82.35
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$82.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$86.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$86.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.62
|
| Rate for Payer: Healthfirst Commercial |
$91.50
|
| Rate for Payer: Healthfirst Essential Plan |
$205.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$86.92
|
| Rate for Payer: Healthfirst QHP |
$91.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$64.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.50
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$77.78
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$64.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$68.62
|
| Rate for Payer: SOMOS Essential |
$68.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.50
|
|
|
PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST
|
Professional
|
Both
|
$126.53
|
|
|
Service Code
|
HCPCS 95933 26
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$76.09 |
| Rate for Payer: Amida Care Medicaid |
$51.30
|
| Rate for Payer: Cash Price |
$34.24
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.36
|
| Rate for Payer: Healthfirst Commercial |
$33.82
|
| Rate for Payer: Healthfirst Essential Plan |
$76.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.13
|
| Rate for Payer: Healthfirst QHP |
$33.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$23.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$28.75
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$23.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$25.36
|
| Rate for Payer: SOMOS Essential |
$25.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.82
|
|
|
PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST
|
Professional
|
Both
|
$222.67
|
|
|
Service Code
|
HCPCS 95933 TC
|
| Min. Negotiated Rate |
$40.38 |
| Max. Negotiated Rate |
$129.78 |
| Rate for Payer: Amida Care Medicaid |
$51.30
|
| Rate for Payer: Cash Price |
$61.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$51.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$54.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$57.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$54.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.26
|
| Rate for Payer: Healthfirst Commercial |
$57.68
|
| Rate for Payer: Healthfirst Essential Plan |
$129.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54.80
|
| Rate for Payer: Healthfirst QHP |
$57.68
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$40.38
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$57.68
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$49.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$40.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.26
|
| Rate for Payer: SOMOS Essential |
$43.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.68
|
|
|
PR ORBITAL IMPLANT INSERTION
|
Professional
|
Both
|
$4,557.07
|
|
|
Service Code
|
HCPCS 67550
|
| Min. Negotiated Rate |
$849.87 |
| Max. Negotiated Rate |
$2,731.72 |
| Rate for Payer: Cash Price |
$1,242.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,214.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,092.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,092.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,153.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,214.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,153.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,214.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,214.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$910.58
|
| Rate for Payer: Healthfirst Commercial |
$1,214.10
|
| Rate for Payer: Healthfirst Essential Plan |
$2,731.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,153.39
|
| Rate for Payer: Healthfirst QHP |
$1,214.10
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$849.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,214.10
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,031.98
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$849.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,214.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$910.58
|
| Rate for Payer: SOMOS Essential |
$910.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,214.10
|
|
|
PR ORBITAL IMPLANT REMOVAL/REVISION
|
Professional
|
Both
|
$4,642.79
|
|
|
Service Code
|
HCPCS 67560
|
| Min. Negotiated Rate |
$867.14 |
| Max. Negotiated Rate |
$2,787.23 |
| Rate for Payer: Cash Price |
$1,270.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,238.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,114.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,114.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,176.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,238.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,176.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,238.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,238.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$929.08
|
| Rate for Payer: Healthfirst Commercial |
$1,238.77
|
| Rate for Payer: Healthfirst Essential Plan |
$2,787.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,176.83
|
| Rate for Payer: Healthfirst QHP |
$1,238.77
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$867.14
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,238.77
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,052.95
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$867.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,238.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$929.08
|
| Rate for Payer: SOMOS Essential |
$929.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,238.77
|
|
|
PR ORBITAL REPOSITIONING W/BONE GRAFTS EXTRACRANIAL
|
Professional
|
Both
|
$6,995.84
|
|
|
Service Code
|
HCPCS 21267
|
| Min. Negotiated Rate |
$1,308.62 |
| Max. Negotiated Rate |
$4,206.26 |
| Rate for Payer: Cash Price |
$1,880.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,869.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,682.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,682.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,775.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,869.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,775.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,869.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,869.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,402.09
|
| Rate for Payer: Healthfirst Commercial |
$1,869.45
|
| Rate for Payer: Healthfirst Essential Plan |
$4,206.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,775.98
|
| Rate for Payer: Healthfirst QHP |
$1,869.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,308.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,869.45
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,589.03
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,308.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,869.45
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,402.09
|
| Rate for Payer: SOMOS Essential |
$1,402.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,869.45
|
|
|
PR ORBITAL REPOSITIONING W/BONE GRAFTS ICRA & XTRC
|
Professional
|
Both
|
$8,773.84
|
|
|
Service Code
|
HCPCS 21268
|
| Min. Negotiated Rate |
$1,642.59 |
| Max. Negotiated Rate |
$5,279.74 |
| Rate for Payer: Cash Price |
$2,359.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,346.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,111.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,111.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,229.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,346.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,229.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,346.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,346.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,759.91
|
| Rate for Payer: Healthfirst Commercial |
$2,346.55
|
| Rate for Payer: Healthfirst Essential Plan |
$5,279.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,229.22
|
| Rate for Payer: Healthfirst QHP |
$2,346.55
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,642.59
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,346.55
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,994.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,642.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,346.55
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,759.91
|
| Rate for Payer: SOMOS Essential |
$1,759.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,346.55
|
|
|
PR ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ
|
Professional
|
Both
|
$13,759.20
|
|
|
Service Code
|
HCPCS 61584
|
| Min. Negotiated Rate |
$2,488.61 |
| Max. Negotiated Rate |
$7,999.09 |
| Rate for Payer: Cash Price |
$3,601.48
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,555.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,199.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,199.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,377.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,555.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,377.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,555.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,555.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,666.36
|
| Rate for Payer: Healthfirst Commercial |
$3,555.15
|
| Rate for Payer: Healthfirst Essential Plan |
$7,999.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,377.39
|
| Rate for Payer: Healthfirst QHP |
$3,555.15
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,488.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,555.15
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,021.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,488.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,555.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,666.36
|
| Rate for Payer: SOMOS Essential |
$2,666.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,555.15
|
|
|
PR ORBITOCRANIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ
|
Professional
|
Both
|
$15,701.39
|
|
|
Service Code
|
HCPCS 61585
|
| Min. Negotiated Rate |
$2,846.70 |
| Max. Negotiated Rate |
$9,150.12 |
| Rate for Payer: Cash Price |
$4,130.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,066.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,660.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,660.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,863.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,066.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,863.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,066.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,066.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,050.04
|
| Rate for Payer: Healthfirst Commercial |
$4,066.72
|
| Rate for Payer: Healthfirst Essential Plan |
$9,150.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,863.38
|
| Rate for Payer: Healthfirst QHP |
$4,066.72
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,846.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,066.72
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,456.71
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,846.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,066.72
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,050.04
|
| Rate for Payer: SOMOS Essential |
$3,050.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,066.72
|
|
|
PR ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE
|
Professional
|
Both
|
$15,005.94
|
|
|
Service Code
|
HCPCS 61592
|
| Min. Negotiated Rate |
$2,732.20 |
| Max. Negotiated Rate |
$8,782.07 |
| Rate for Payer: Cash Price |
$3,973.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,903.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,512.83
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,512.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,707.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,903.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,707.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,903.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,903.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,927.36
|
| Rate for Payer: Healthfirst Commercial |
$3,903.14
|
| Rate for Payer: Healthfirst Essential Plan |
$8,782.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,707.98
|
| Rate for Payer: Healthfirst QHP |
$3,903.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2,732.20
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,903.14
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$3,317.67
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2,732.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,903.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,927.36
|
| Rate for Payer: SOMOS Essential |
$2,927.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,903.14
|
|
|
PR ORBITOTOMY BONE FLAP/WINDOW LATERAL RMVL FB
|
Professional
|
Both
|
$5,795.83
|
|
|
Service Code
|
HCPCS 67430
|
| Min. Negotiated Rate |
$1,080.57 |
| Max. Negotiated Rate |
$3,473.26 |
| Rate for Payer: Cash Price |
$1,584.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,543.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,389.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,389.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,466.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,543.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,466.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,543.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,543.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,157.75
|
| Rate for Payer: Healthfirst Commercial |
$1,543.67
|
| Rate for Payer: Healthfirst Essential Plan |
$3,473.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,466.49
|
| Rate for Payer: Healthfirst QHP |
$1,543.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,080.57
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,543.67
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,312.12
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,080.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,543.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,157.75
|
| Rate for Payer: SOMOS Essential |
$1,157.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,543.67
|
|
|
PR ORBITOTOMY BONE FLAP/WINDOW LATERAL W/DRG
|
Professional
|
Both
|
$5,622.16
|
|
|
Service Code
|
HCPCS 67440
|
| Min. Negotiated Rate |
$1,049.01 |
| Max. Negotiated Rate |
$3,371.83 |
| Rate for Payer: Cash Price |
$1,537.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,498.59
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,348.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,348.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,423.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,498.59
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,423.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,498.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,498.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,123.94
|
| Rate for Payer: Healthfirst Commercial |
$1,498.59
|
| Rate for Payer: Healthfirst Essential Plan |
$3,371.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,423.66
|
| Rate for Payer: Healthfirst QHP |
$1,498.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,049.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,498.59
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,273.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,049.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,498.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,123.94
|
| Rate for Payer: SOMOS Essential |
$1,123.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,498.59
|
|
|
PR ORBITOTOMY BONE FLAP/WINDOW LAT EXPL W/WO BX
|
Professional
|
Both
|
$5,825.12
|
|
|
Service Code
|
HCPCS 67450
|
| Min. Negotiated Rate |
$1,086.93 |
| Max. Negotiated Rate |
$3,493.71 |
| Rate for Payer: Cash Price |
$1,592.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,552.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,397.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,397.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,475.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,552.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,475.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,552.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,552.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,164.57
|
| Rate for Payer: Healthfirst Commercial |
$1,552.76
|
| Rate for Payer: Healthfirst Essential Plan |
$3,493.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,475.12
|
| Rate for Payer: Healthfirst QHP |
$1,552.76
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,086.93
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,552.76
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,319.85
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,086.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,552.76
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,164.57
|
| Rate for Payer: SOMOS Essential |
$1,164.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,552.76
|
|
|
PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN
|
Professional
|
Both
|
$6,366.85
|
|
|
Service Code
|
HCPCS 67445
|
| Min. Negotiated Rate |
$1,190.66 |
| Max. Negotiated Rate |
$3,827.11 |
| Rate for Payer: Cash Price |
$1,742.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,700.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,530.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,530.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,615.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,700.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,615.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,275.70
|
| Rate for Payer: Healthfirst Commercial |
$1,700.94
|
| Rate for Payer: Healthfirst Essential Plan |
$3,827.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,615.89
|
| Rate for Payer: Healthfirst QHP |
$1,700.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,190.66
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,700.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,445.80
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,190.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,700.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,275.70
|
| Rate for Payer: SOMOS Essential |
$1,275.70
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,700.94
|
|
|
PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL LESION
|
Professional
|
Both
|
$7,364.25
|
|
|
Service Code
|
HCPCS 67420
|
| Min. Negotiated Rate |
$1,356.24 |
| Max. Negotiated Rate |
$4,359.33 |
| Rate for Payer: Cash Price |
$1,984.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,937.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,743.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,743.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,840.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,937.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,840.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,937.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,937.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,453.11
|
| Rate for Payer: Healthfirst Commercial |
$1,937.48
|
| Rate for Payer: Healthfirst Essential Plan |
$4,359.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,840.61
|
| Rate for Payer: Healthfirst QHP |
$1,937.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,356.24
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,937.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,646.86
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,356.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,937.48
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,453.11
|
| Rate for Payer: SOMOS Essential |
$1,453.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,937.48
|
|
|
PR ORBITOTOMY W/O BONE FLAP EXPL W/DRAINAGE ONLY
|
Professional
|
Both
|
$3,814.65
|
|
|
Service Code
|
HCPCS 67405
|
| Min. Negotiated Rate |
$706.87 |
| Max. Negotiated Rate |
$2,272.09 |
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,009.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$908.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$908.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$959.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,009.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$959.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,009.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,009.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$757.37
|
| Rate for Payer: Healthfirst Commercial |
$1,009.82
|
| Rate for Payer: Healthfirst Essential Plan |
$2,272.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$959.33
|
| Rate for Payer: Healthfirst QHP |
$1,009.82
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$706.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,009.82
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$858.35
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$706.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,009.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$757.37
|
| Rate for Payer: SOMOS Essential |
$757.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,009.82
|
|
|
PR ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY
|
Professional
|
Both
|
$4,347.35
|
|
|
Service Code
|
HCPCS 67400
|
| Min. Negotiated Rate |
$809.47 |
| Max. Negotiated Rate |
$2,601.86 |
| Rate for Payer: Cash Price |
$1,187.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,156.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,040.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,040.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,098.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,156.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,098.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,156.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$867.28
|
| Rate for Payer: Healthfirst Commercial |
$1,156.38
|
| Rate for Payer: Healthfirst Essential Plan |
$2,601.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,098.56
|
| Rate for Payer: Healthfirst QHP |
$1,156.38
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$809.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,156.38
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$982.92
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$809.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,156.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$867.28
|
| Rate for Payer: SOMOS Essential |
$867.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,156.38
|
|
|
PR ORBITOTOMY W/O BONE FLAP W/REMOVAL LESION
|
Professional
|
Both
|
$4,166.47
|
|
|
Service Code
|
HCPCS 67412
|
| Min. Negotiated Rate |
$771.36 |
| Max. Negotiated Rate |
$2,479.36 |
| Rate for Payer: Cash Price |
$1,134.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,101.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$991.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$991.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,046.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,101.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,046.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,101.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,101.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$826.46
|
| Rate for Payer: Healthfirst Commercial |
$1,101.94
|
| Rate for Payer: Healthfirst Essential Plan |
$2,479.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,046.84
|
| Rate for Payer: Healthfirst QHP |
$1,101.94
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$771.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,101.94
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$936.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$771.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,101.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$826.46
|
| Rate for Payer: SOMOS Essential |
$826.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,101.94
|
|
|
PR ORBITOTOMY W/O BONE FLAP W/RMVL BONE DCMPRN
|
Professional
|
Both
|
$6,098.09
|
|
|
Service Code
|
HCPCS 67414
|
| Min. Negotiated Rate |
$1,133.56 |
| Max. Negotiated Rate |
$3,643.58 |
| Rate for Payer: Cash Price |
$1,661.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,619.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,457.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,457.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,538.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,619.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,538.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,619.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,619.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,214.53
|
| Rate for Payer: Healthfirst Commercial |
$1,619.37
|
| Rate for Payer: Healthfirst Essential Plan |
$3,643.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,538.40
|
| Rate for Payer: Healthfirst QHP |
$1,619.37
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,133.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,619.37
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,376.46
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,133.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,619.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,214.53
|
| Rate for Payer: SOMOS Essential |
$1,214.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,619.37
|
|
