|
TAMSULOSIN 0.4 MG CAP
|
Facility
OP
|
$0.78
|
|
| Hospital Charge Code |
41642065
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.53
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.51
|
|
|
TAMSULOSIN 0.4 MG CAP
|
Facility
OP
|
$0.78
|
|
| Hospital Charge Code |
41652065
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.43
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.53
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.51
|
|
|
TANDEM COCR SHELL 22 42
|
Facility
OP
|
$2,085.63
|
|
| Hospital Charge Code |
64905049
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$729.97 |
| Max. Negotiated Rate |
$1,668.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,147.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,042.82
|
| Rate for Payer: Aetna Government |
$1,042.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,668.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,418.23
|
| Rate for Payer: Group Health Inc Commercial |
$1,042.82
|
| Rate for Payer: Group Health Inc Medicare |
$729.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,042.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,042.82
|
|
|
TANDEM RX CANNULA TAPERED 210CM
|
Facility
OP
|
$148.00
|
|
| Hospital Charge Code |
40201004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.00
|
| Rate for Payer: Aetna Government |
$74.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$118.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$100.64
|
| Rate for Payer: Group Health Inc Commercial |
$74.00
|
| Rate for Payer: Group Health Inc Medicare |
$51.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.00
|
|
|
TANDEM SHELL 46MM
|
Facility
OP
|
$2,085.63
|
|
| Hospital Charge Code |
64905355
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$729.97 |
| Max. Negotiated Rate |
$1,668.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,147.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,042.82
|
| Rate for Payer: Aetna Government |
$1,042.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,668.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,418.23
|
| Rate for Payer: Group Health Inc Commercial |
$1,042.82
|
| Rate for Payer: Group Health Inc Medicare |
$729.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,042.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,042.82
|
|
|
TANDEM SHELL OD 28MM 48MM ID
|
Facility
OP
|
$2,085.63
|
|
| Hospital Charge Code |
64904004
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$729.97 |
| Max. Negotiated Rate |
$1,668.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,147.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,042.82
|
| Rate for Payer: Aetna Government |
$1,042.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,668.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,418.23
|
| Rate for Payer: Group Health Inc Commercial |
$1,042.82
|
| Rate for Payer: Group Health Inc Medicare |
$729.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,042.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,042.82
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
OP
|
$356.37
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
42501051
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Government |
$19.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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: Fidelis CHP/HARP/Medicaid |
$23.18
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.76
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
OP
|
$356.37
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
42201202
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Government |
$19.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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: Fidelis CHP/HARP/Medicaid |
$23.18
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.76
|
|
|
TANGNTL BX SKIN EA SEP/ADDL
|
Facility
OP
|
$356.37
|
|
|
Service Code
|
HCPCS 11103
|
| Hospital Charge Code |
30307937
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Government |
$19.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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: Fidelis CHP/HARP/Medicaid |
$23.18
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.76
|
|
|
TANGNTL BX SKIN SGL LES
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
42201201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
42501050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
66543700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$231.52
|
| Rate for Payer: Group Health Inc Medicare |
$231.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
TANGNTL BX SKIN SINGLE LES
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11102
|
| Hospital Charge Code |
30307913
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
TAN NAIL 8.5X36CM
|
Facility
OP
|
$3,720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,906.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,046.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,860.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,139.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,906.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,860.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,302.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,860.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,860.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,418.00
|
|
|
TAN NAIL 8.5X36CM
|
Facility
IP
|
$3,720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202304
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,860.00 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,860.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,860.00
|
|
|
T & A, OVER AGE 12
|
Facility
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 42821
|
| Hospital Charge Code |
40109208
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$339.96 |
| Max. Negotiated Rate |
$3,966.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| 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 |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$339.96
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$377.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
TAP
|
Facility
IP
|
$748.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$374.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$374.00
|
|
|
TAP
|
Facility
OP
|
$748.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200315
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$785.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$411.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$374.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$430.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$785.40
|
| Rate for Payer: Group Health Inc Commercial |
$374.00
|
| Rate for Payer: Group Health Inc Medicare |
$261.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$374.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$374.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$486.20
|
|
|
TAP 3.0MM
|
Facility
OP
|
$900.00
|
|
| Hospital Charge Code |
40205528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$315.00 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$495.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$450.00
|
| Rate for Payer: Aetna Government |
$450.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$720.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$612.00
|
| Rate for Payer: Group Health Inc Commercial |
$450.00
|
| Rate for Payer: Group Health Inc Medicare |
$315.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$450.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$450.00
|
|
|
TAP BONE CANNULATED 5MM DIA 30
|
Facility
IP
|
$1,415.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.50 |
| Max. Negotiated Rate |
$707.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$707.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$707.50
|
|
|
TAP BONE CANNULATED 5MM DIA 30
|
Facility
OP
|
$1,415.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904941
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,485.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$778.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$707.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$813.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,485.75
|
| Rate for Payer: Group Health Inc Commercial |
$707.50
|
| Rate for Payer: Group Health Inc Medicare |
$495.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$707.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$707.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$919.75
|
|
|
TAP CANNLTD SERATO 5.5
|
Facility
IP
|
$3,324.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.24 |
| Max. Negotiated Rate |
$1,662.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,662.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,662.24
|
|
|
TAP CANNLTD SERATO 5.5
|
Facility
OP
|
$3,324.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,490.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,828.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,662.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,911.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,490.70
|
| Rate for Payer: Group Health Inc Commercial |
$1,662.24
|
| Rate for Payer: Group Health Inc Medicare |
$1,163.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,662.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,662.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,160.91
|
|
|
TAP CANNULATED 6.0
|
Facility
IP
|
$3,292.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$1,646.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,646.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,646.25
|
|
|
TAP CANNULATED 6.0
|
Facility
OP
|
$3,292.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64907514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,457.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,810.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,646.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,893.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,457.12
|
| Rate for Payer: Group Health Inc Commercial |
$1,646.25
|
| Rate for Payer: Group Health Inc Medicare |
$1,152.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,646.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,646.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,140.12
|
|
