|
TEFLON GRAFT
|
Facility
OP
|
$208.73
|
|
| Hospital Charge Code |
40000380
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$166.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$104.36
|
| Rate for Payer: Aetna Government |
$104.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$166.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$141.94
|
| Rate for Payer: Group Health Inc Commercial |
$104.36
|
| Rate for Payer: Group Health Inc Medicare |
$73.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.36
|
|
|
TEGRETOL (CARBAMAZEPINE)
|
Facility
OP
|
$36.43
|
|
|
Service Code
|
HCPCS 80156
|
| Hospital Charge Code |
40602015
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$23.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.57
|
| Rate for Payer: Aetna Government |
$14.57
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.57
|
| Rate for Payer: EmblemHealth Commercial |
$14.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.97
|
| Rate for Payer: Group Health Inc Commercial |
$14.57
|
| Rate for Payer: Group Health Inc Medicare |
$14.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.57
|
| Rate for Payer: Healthfirst QHP |
$14.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.66
|
| Rate for Payer: Wellcare Medicare |
$13.11
|
|
|
TELEDENTISTRY - ASYNCHRONOUS
|
Facility
OP
|
$12.56
|
|
|
Service Code
|
HCPCS D9996
|
| Hospital Charge Code |
42300734
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.28
|
| Rate for Payer: Aetna Government |
$6.28
|
| 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: Group Health Inc Commercial |
$6.28
|
| Rate for Payer: Group Health Inc Medicare |
$4.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.28
|
|
|
TELEDENTTISTRY - SYNCHRONOUS
|
Facility
OP
|
$23.48
|
|
|
Service Code
|
HCPCS D9995
|
| Hospital Charge Code |
42300733
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.74
|
| Rate for Payer: Aetna Government |
$11.74
|
| 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: Group Health Inc Commercial |
$11.74
|
| Rate for Payer: Group Health Inc Medicare |
$8.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.74
|
|
|
TELEHEALTH FACILITY FEE
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
30300134
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.65
|
| Rate for Payer: Aetna Government |
$26.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
| Rate for Payer: Group Health Inc Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Medicare |
$45.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
|
|
TELEHEATLH ORIG SITE FACLITY FEE
|
Facility
OP
|
$69.40
|
|
|
Service Code
|
HCPCS Q3014
|
| Hospital Charge Code |
42300729
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.29 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.65
|
| Rate for Payer: Aetna Government |
$26.65
|
| 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: Group Health Inc Commercial |
$34.70
|
| Rate for Payer: Group Health Inc Medicare |
$24.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.70
|
|
|
TELEMEDICINE PSYCH DIAG EVAL
|
Facility
OP
|
$406.00
|
|
|
Service Code
|
HCPCS 90791 95
|
| Hospital Charge Code |
30300990
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$324.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$213.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$203.00
|
| Rate for Payer: Aetna Government |
$203.00
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$324.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$276.08
|
| Rate for Payer: Group Health Inc Commercial |
$203.00
|
| Rate for Payer: Group Health Inc Medicare |
$142.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.00
|
|
|
TELEMEDICINE PSYCH DIAG EVAL/W SV
|
Facility
OP
|
$406.00
|
|
|
Service Code
|
HCPCS 90792 95
|
| Hospital Charge Code |
30300998
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$324.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$213.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$203.00
|
| Rate for Payer: Aetna Government |
$203.00
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$324.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$276.08
|
| Rate for Payer: Group Health Inc Commercial |
$203.00
|
| Rate for Payer: Group Health Inc Medicare |
$142.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$203.00
|
|
|
TELEPHONIC 11-20MINS MEDCL DISCUS
|
Facility
OP
|
$263.60
|
|
|
Service Code
|
HCPCS 99442
|
| Hospital Charge Code |
30300898
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$20.06 |
| Max. Negotiated Rate |
$210.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$144.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.06
|
| Rate for Payer: Aetna Government |
$20.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$210.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$179.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.24
|
| Rate for Payer: Group Health Inc Commercial |
$131.80
|
| Rate for Payer: Group Health Inc Medicare |
$92.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$76.93
|
|
|
TELEPHONIC 21-30MINS MEDCL DISCUS
|
Facility
OP
|
$395.40
|
|
|
Service Code
|
HCPCS 99443
|
| Hospital Charge Code |
30300899
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$28.36 |
| Max. Negotiated Rate |
$316.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$217.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.36
|
| Rate for Payer: Aetna Government |
$28.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$316.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$268.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.59
|
| Rate for Payer: Group Health Inc Commercial |
$197.70
|
| Rate for Payer: Group Health Inc Medicare |
$138.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$197.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.77
|
|
|
TELEPHONIC 5-10MINS MEDCL DISCUSS
|
Facility
OP
|
$131.80
|
|
|
Service Code
|
HCPCS 99441
|
| Hospital Charge Code |
30300897
|
|
Hospital Revenue Code
|
780
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$105.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.41
|
| Rate for Payer: Aetna Government |
$9.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$89.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$36.08
|
| Rate for Payer: Group Health Inc Commercial |
$65.90
|
| Rate for Payer: Group Health Inc Medicare |
$46.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.09
|
|
|
TELEPH. SINGLE CHAMBR PCMKR CHECK
|
Facility
OP
|
$109.80
|
|
|
Service Code
|
HCPCS 93293 TC
|
| Hospital Charge Code |
40804105
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$35.08 |
| Max. Negotiated Rate |
$87.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.90
|
| Rate for Payer: Aetna Government |
$54.90
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cash Price |
$43.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$35.08
|
| Rate for Payer: Group Health Inc Commercial |
$54.90
|
| Rate for Payer: Group Health Inc Medicare |
$38.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.98
|
|
|
TELESCOPE GUIDE EXTENSION
|
Facility
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.21
|
| Rate for Payer: Aetna Government |
$3.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$575.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,050.00
|
| Rate for Payer: Group Health Inc Commercial |
$500.00
|
| Rate for Payer: Group Health Inc Medicare |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$500.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$650.00
|
|
|
TELESCOPE GUIDE EXTENSION
|
Facility
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
66521493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$500.00 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$500.00
|
|
|
TELE-TERMOMETER W/PROBE
|
Facility
OP
|
$122.26
|
|
| Hospital Charge Code |
40206002
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$97.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.13
|
| Rate for Payer: Aetna Government |
$61.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.14
|
| Rate for Payer: Group Health Inc Commercial |
$61.13
|
| Rate for Payer: Group Health Inc Medicare |
$42.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.13
|
|
|
TELETHERAPY ISODOSE COMP PLAN
|
Facility
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77307 TC
|
| Hospital Charge Code |
66542935
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$166.18 |
| Max. Negotiated Rate |
$812.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$507.56
|
| Rate for Payer: Aetna Government |
$507.56
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$812.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$507.56
|
| Rate for Payer: Group Health Inc Medicare |
$355.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$166.18
|
|
|
TELETHX ISODOSE PLAN SIMP
|
Facility
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77306 TC
|
| Hospital Charge Code |
66542934
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$91.92 |
| Max. Negotiated Rate |
$812.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$507.56
|
| Rate for Payer: Aetna Government |
$507.56
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$812.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$507.56
|
| Rate for Payer: Group Health Inc Medicare |
$355.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.92
|
|
|
TELETHX ISODOSE PLAN SIMPLE
|
Facility
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77306 TC
|
| Hospital Charge Code |
66541263
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$91.92 |
| Max. Negotiated Rate |
$812.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$507.56
|
| Rate for Payer: Aetna Government |
$507.56
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$812.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$507.56
|
| Rate for Payer: Group Health Inc Medicare |
$355.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$507.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.92
|
|
|
TEMAZEPAM 15 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640175
|
|
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
|
|
|
TEMAZEPAM 15 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650175
|
|
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
|
|
|
TEMP ANCHORAGE DEV W FLAP
|
Facility
OP
|
$320.00
|
|
|
Service Code
|
HCPCS D7293
|
| Hospital Charge Code |
42303427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$110.12
|
| Rate for Payer: Aetna Government |
$110.12
|
| 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: Group Health Inc Commercial |
$160.00
|
| Rate for Payer: Group Health Inc Medicare |
$112.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.00
|
|
|
TEMP ANCHORAGE DEV W/O FLAP
|
Facility
OP
|
$320.00
|
|
|
Service Code
|
HCPCS D7294
|
| Hospital Charge Code |
42303428
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.96
|
| Rate for Payer: Aetna Government |
$91.96
|
| 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: Group Health Inc Commercial |
$160.00
|
| Rate for Payer: Group Health Inc Medicare |
$112.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.00
|
|
|
TEMP FIX PINS
|
Facility
OP
|
$217.50
|
|
| Hospital Charge Code |
64906015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$76.12 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$108.75
|
| Rate for Payer: Aetna Government |
$108.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$174.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$147.90
|
| Rate for Payer: Group Health Inc Commercial |
$108.75
|
| Rate for Payer: Group Health Inc Medicare |
$76.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.75
|
|
|
TEMPLATE BENDING HOLEX12 F/3.5
|
Facility
OP
|
$135.00
|
|
| Hospital Charge Code |
64905568
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.50
|
| Rate for Payer: Aetna Government |
$67.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$108.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$91.80
|
| Rate for Payer: Group Health Inc Commercial |
$67.50
|
| Rate for Payer: Group Health Inc Medicare |
$47.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.50
|
|
|
TEMPLATE,ENDOFORM,DERMAL,2X2,FE
|
Facility
OP
|
$25.23
|
|
| Hospital Charge Code |
64903676
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$20.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.62
|
| Rate for Payer: Aetna Government |
$12.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.16
|
| Rate for Payer: Group Health Inc Commercial |
$12.62
|
| Rate for Payer: Group Health Inc Medicare |
$8.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.62
|
|
