|
ASPIRIN 81 MG ECT
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41642563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ASPIRIN 81 MG ECT
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41652563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ASPIRIN + DIPYRIDAMOLE 25 MG-200 MG CAP
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41642640
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
ASPIRIN + DIPYRIDAMOLE 25 MG-200 MG CAP
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41652640
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
ASP OF BLADDER WITH CATH INSERT
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
30105796
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$2,355.42
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,355.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
ASP OF BLADDER WITH CATH INSERT
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
30305796
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$153.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$2,355.42
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,355.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
ASSAY ALKALINE PHOSPHATASES
|
Facility
OP
|
$36.95
|
|
|
Service Code
|
HCPCS 84080
|
| Hospital Charge Code |
40609605
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$23.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.78
|
| Rate for Payer: Aetna Government |
$14.78
|
| Rate for Payer: Cash Price |
$14.78
|
| Rate for Payer: Cash Price |
$14.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.78
|
| Rate for Payer: EmblemHealth Commercial |
$14.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.30
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.15
|
| Rate for Payer: Group Health Inc Commercial |
$14.78
|
| Rate for Payer: Group Health Inc Medicare |
$14.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.78
|
| Rate for Payer: Healthfirst QHP |
$14.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.82
|
| Rate for Payer: Wellcare Medicare |
$13.30
|
|
|
ASSAY OF APOLIPOPROTEIN
|
Facility
OP
|
$52.78
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
40729625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$29.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.09
|
| Rate for Payer: Aetna Government |
$21.09
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.09
|
| Rate for Payer: EmblemHealth Commercial |
$21.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.77
|
| Rate for Payer: Group Health Inc Commercial |
$21.09
|
| Rate for Payer: Group Health Inc Medicare |
$21.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.09
|
| Rate for Payer: Healthfirst QHP |
$21.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.87
|
| Rate for Payer: Wellcare Medicare |
$18.98
|
|
|
ASSAY OF SWEAT SODIUM
|
Facility
OP
|
$12.15
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
40609607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.86
|
| Rate for Payer: Aetna Government |
$4.86
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.86
|
| Rate for Payer: EmblemHealth Commercial |
$4.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.33
|
| Rate for Payer: Group Health Inc Commercial |
$4.86
|
| Rate for Payer: Group Health Inc Medicare |
$4.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.86
|
| Rate for Payer: Healthfirst QHP |
$4.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.89
|
| Rate for Payer: Wellcare Medicare |
$4.37
|
|
|
ASSAY OF TOTAL ESTRADIOL
|
Facility
OP
|
$69.85
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
40609069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.94
|
| Rate for Payer: Aetna Government |
$27.94
|
| Rate for Payer: Cash Price |
$27.94
|
| Rate for Payer: Cash Price |
$27.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.94
|
| Rate for Payer: EmblemHealth Commercial |
$27.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.87
|
| Rate for Payer: Group Health Inc Commercial |
$27.94
|
| Rate for Payer: Group Health Inc Medicare |
$27.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.94
|
| Rate for Payer: Healthfirst QHP |
$27.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.35
|
| Rate for Payer: Wellcare Medicare |
$25.15
|
|
|
ASSAY OF TOTL ESTRADIOL
|
Facility
OP
|
$69.85
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
40609068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$44.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.94
|
| Rate for Payer: Aetna Government |
$27.94
|
| Rate for Payer: Cash Price |
$27.94
|
| Rate for Payer: Cash Price |
$27.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.94
|
| Rate for Payer: EmblemHealth Commercial |
$27.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$25.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.87
|
| Rate for Payer: Group Health Inc Commercial |
$27.94
|
| Rate for Payer: Group Health Inc Medicare |
$27.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.94
|
| Rate for Payer: Healthfirst QHP |
$27.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.35
|
| Rate for Payer: Wellcare Medicare |
$25.15
|
|
|
ASSAY OTHER FLUID CHLORIDES
|
Facility
OP
|
$12.50
|
|
|
Service Code
|
HCPCS 82438
|
| Hospital Charge Code |
40609608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.00
|
| Rate for Payer: EmblemHealth Commercial |
$5.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.45
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.00
|
| Rate for Payer: Healthfirst QHP |
$5.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.00
|
| Rate for Payer: Wellcare Medicare |
$4.50
|
|
|
ASSEMBLED FRAME,LENS, ASSTD
|
Facility
OP
|
$6.95
|
|
| Hospital Charge Code |
64901168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$5.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.48
|
| Rate for Payer: Aetna Government |
$3.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.73
|
| Rate for Payer: Group Health Inc Commercial |
$3.48
|
| Rate for Payer: Group Health Inc Medicare |
$2.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.48
|
|
|
ASSEMBLY BULB & VALVE BP UNIT
|
Facility
OP
|
$20.12
|
|
| Hospital Charge Code |
64902205
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.06
|
| Rate for Payer: Aetna Government |
$10.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.68
|
| Rate for Payer: Group Health Inc Commercial |
$10.06
|
| Rate for Payer: Group Health Inc Medicare |
$7.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.06
|
|
|
ASSISTED METHADONE TRMNT
|
Facility
OP
|
$258.63
|
|
|
Service Code
|
HCPCS G2067
|
| Hospital Charge Code |
30300189
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$233.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$142.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$233.15
|
| Rate for Payer: Aetna Government |
$233.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.87
|
| Rate for Payer: Group Health Inc Commercial |
$129.32
|
| Rate for Payer: Group Health Inc Medicare |
$90.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.32
|
|
|
ASST BUPRENORPHINE IMPLNT INSERT
|
Facility
OP
|
$258.63
|
|
|
Service Code
|
HCPCS G2070
|
| Hospital Charge Code |
30300195
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$5,387.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$142.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,387.61
|
| Rate for Payer: Aetna Government |
$5,387.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.87
|
| Rate for Payer: Group Health Inc Commercial |
$129.32
|
| Rate for Payer: Group Health Inc Medicare |
$90.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.32
|
|
|
ASST BUPRENORPHINE IMPLNT REMOVAL
|
Facility
OP
|
$258.63
|
|
|
Service Code
|
HCPCS G2071
|
| Hospital Charge Code |
30300196
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$490.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$142.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$490.99
|
| Rate for Payer: Aetna Government |
$490.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.87
|
| Rate for Payer: Group Health Inc Commercial |
$129.32
|
| Rate for Payer: Group Health Inc Medicare |
$90.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.32
|
|
|
ASST BUPRENORPHINE IMPLT INS&RMVL
|
Facility
OP
|
$258.63
|
|
|
Service Code
|
HCPCS G2071
|
| Hospital Charge Code |
30300197
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$490.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$142.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$490.99
|
| Rate for Payer: Aetna Government |
$490.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.87
|
| Rate for Payer: Group Health Inc Commercial |
$129.32
|
| Rate for Payer: Group Health Inc Medicare |
$90.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.32
|
|
|
ASSTD BUPRENORPHINE(INJ) TRM WKLY
|
Facility
OP
|
$258.63
|
|
|
Service Code
|
HCPCS G2069
|
| Hospital Charge Code |
30300194
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$1,783.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$142.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,783.91
|
| Rate for Payer: Aetna Government |
$1,783.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.87
|
| Rate for Payer: Group Health Inc Commercial |
$129.32
|
| Rate for Payer: Group Health Inc Medicare |
$90.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.32
|
|
|
ASSTD BUPRENORPHINE(ORAL) TRM
|
Facility
OP
|
$82.54
|
|
|
Service Code
|
HCPCS G2068
|
| Hospital Charge Code |
30300193
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$28.89 |
| Max. Negotiated Rate |
$284.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$284.13
|
| Rate for Payer: Aetna Government |
$284.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.13
|
| Rate for Payer: Group Health Inc Commercial |
$41.27
|
| Rate for Payer: Group Health Inc Medicare |
$28.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.27
|
|
|
ASSTD MED NOT OTHERWISE SPECIFIED
|
Facility
OP
|
$397.85
|
|
|
Service Code
|
HCPCS G2075
|
| Hospital Charge Code |
30300201
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$139.25 |
| Max. Negotiated Rate |
$318.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$218.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$198.92
|
| Rate for Payer: Aetna Government |
$198.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.54
|
| Rate for Payer: Group Health Inc Commercial |
$198.92
|
| Rate for Payer: Group Health Inc Medicare |
$139.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$198.92
|
|
|
ASSTD MED TRMT DRUG NOT INCLUDED
|
Facility
OP
|
$358.63
|
|
|
Service Code
|
HCPCS G2074
|
| Hospital Charge Code |
30300199
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$125.52 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$197.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$185.80
|
| Rate for Payer: Aetna Government |
$185.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$286.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$243.87
|
| Rate for Payer: Group Health Inc Commercial |
$179.32
|
| Rate for Payer: Group Health Inc Medicare |
$125.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$179.32
|
|
|
ASSTD NALTREXONE TRMT
|
Facility
OP
|
$258.63
|
|
|
Service Code
|
HCPCS G2073
|
| Hospital Charge Code |
30300198
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$90.52 |
| Max. Negotiated Rate |
$1,369.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$142.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,369.29
|
| Rate for Payer: Aetna Government |
$1,369.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.87
|
| Rate for Payer: Group Health Inc Commercial |
$129.32
|
| Rate for Payer: Group Health Inc Medicare |
$90.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.32
|
|
|
ASSY CBLE-RDY CERCLAGE SST 128
|
Facility
OP
|
$1,152.00
|
|
| Hospital Charge Code |
64906701
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$403.20 |
| Max. Negotiated Rate |
$921.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$633.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$576.00
|
| Rate for Payer: Aetna Government |
$576.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$921.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$783.36
|
| Rate for Payer: Group Health Inc Commercial |
$576.00
|
| Rate for Payer: Group Health Inc Medicare |
$403.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$576.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$576.00
|
|
|
ASYMMETRICAL PATELLA SER A
|
Facility
IP
|
$1,852.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64903855
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.25 |
| Max. Negotiated Rate |
$926.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$926.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$926.25
|
|
