|
TRIAMCINOLONE 0.1% PASTE 5 GRAMS
|
Facility
OP
|
$80.00
|
|
| Hospital Charge Code |
41643628
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.00
|
| Rate for Payer: Aetna Government |
$40.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.40
|
| Rate for Payer: Group Health Inc Commercial |
$40.00
|
| Rate for Payer: Group Health Inc Medicare |
$28.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.00
|
|
|
TRIAMCINOLONE 0.1% PASTE 5 GRAMS
|
Facility
OP
|
$80.00
|
|
| Hospital Charge Code |
41653628
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.00
|
| Rate for Payer: Aetna Government |
$40.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.40
|
| Rate for Payer: Group Health Inc Commercial |
$40.00
|
| Rate for Payer: Group Health Inc Medicare |
$28.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.00
|
|
|
TRIAMCINOLONE 0.5% CREAM 15 GRAMS
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
41640756
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
TRIAMCINOLONE 0.5% CREAM 15 GRAMS
|
Facility
OP
|
$12.00
|
|
| Hospital Charge Code |
41650756
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$9.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.00
|
| Rate for Payer: Aetna Government |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.16
|
| Rate for Payer: Group Health Inc Commercial |
$6.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.80
|
|
|
TRIAMCINOLONE 0.5% OINT 15 GRAMS
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
41650887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
TRIAMCINOLONE 0.5% OINT 15 GRAMS
|
Facility
OP
|
$4.00
|
|
| Hospital Charge Code |
41640887
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
TRIAMCINOLONE 40MG/ML INJ
|
Facility
OP
|
$6.41
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
41656581
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.88
|
| Rate for Payer: Aetna Government |
$3.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Group Health Inc Commercial |
$3.20
|
| Rate for Payer: Group Health Inc Medicare |
$2.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.17
|
|
|
TRIAMCINOLONE 40MG/ML INJ
|
Facility
IP
|
$6.41
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
41656581
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.20
|
|
|
TRIAMCINOLONE REPOSITORY 10 MG/ML INJ
|
Facility
IP
|
$21.88
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
41640513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.94
|
|
|
TRIAMCINOLONE REPOSITORY 10 MG/ML INJ
|
Facility
OP
|
$21.88
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
41640513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.90
|
| Rate for Payer: Group Health Inc Commercial |
$10.94
|
| Rate for Payer: Group Health Inc Medicare |
$7.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.15
|
| Rate for Payer: SOMOS Essential |
$1.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.22
|
|
|
TRIAMCINOLONE REPOSITORY 10 MG/ML INJ
|
Facility
OP
|
$21.88
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
41650513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.90
|
| Rate for Payer: Group Health Inc Commercial |
$10.94
|
| Rate for Payer: Group Health Inc Medicare |
$7.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.15
|
| Rate for Payer: SOMOS Essential |
$1.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.22
|
|
|
TRIAMCINOLONE REPOSITORY 10 MG/ML INJ
|
Facility
IP
|
$21.88
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
41650513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.94
|
|
|
TRIAMCINOLONE REPOSITORY 40 MG/ML INJ
|
Facility
IP
|
$1.35
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
41652599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.68
|
|
|
TRIAMCINOLONE REPOSITORY 40 MG/ML INJ
|
Facility
OP
|
$1.35
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
41652599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.90
|
| Rate for Payer: Group Health Inc Commercial |
$0.68
|
| Rate for Payer: Group Health Inc Medicare |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.15
|
| Rate for Payer: SOMOS Essential |
$1.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.88
|
|
|
TRIAMCINOLONE REPOSITORY 40 MG/ML INJ
|
Facility
OP
|
$1.35
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
41642599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.90
|
| Rate for Payer: Group Health Inc Commercial |
$0.68
|
| Rate for Payer: Group Health Inc Medicare |
$0.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.15
|
| Rate for Payer: SOMOS Essential |
$1.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.88
|
|
|
TRIAMCINOLONE REPOSITORY 40 MG/ML INJ
|
Facility
IP
|
$1.35
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
41642599
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.68
|
|
|
TRIAMICINOLONE 40MG/ML INJ
|
Facility
IP
|
$6.41
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
41646581
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.20
|
|
|
TRIAMICINOLONE 40MG/ML INJ
|
Facility
OP
|
$6.41
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
41646581
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.88
|
| Rate for Payer: Aetna Government |
$3.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.84
|
| Rate for Payer: Group Health Inc Commercial |
$3.20
|
| Rate for Payer: Group Health Inc Medicare |
$2.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.17
|
|
|
TRIAMTERENE-HCTZ 37.5-25 MG TAB
|
Facility
OP
|
$0.03
|
|
| Hospital Charge Code |
41643488
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
TRIAMTERENE-HCTZ 37.5-25 MG TAB
|
Facility
OP
|
$0.03
|
|
| Hospital Charge Code |
41653488
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.02
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.02
|
|
|
TRIATHLON T KNEE U TIB BP SZ5
|
Facility
IP
|
$7,204.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,602.00 |
| Max. Negotiated Rate |
$3,602.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,602.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,602.00
|
|
|
TRIATHLON T KNEE U TIB BP SZ5
|
Facility
OP
|
$7,204.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205212
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$7,564.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,962.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,602.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,142.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,564.20
|
| Rate for Payer: Group Health Inc Commercial |
$3,602.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,521.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,602.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,602.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,682.60
|
|
|
TRIATHLON TL KNEE PS FEM COMP#4RT
|
Facility
IP
|
$5,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,810.50 |
| Max. Negotiated Rate |
$2,810.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,810.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,810.50
|
|
|
TRIATHLON TL KNEE PS FEM COMP#4RT
|
Facility
OP
|
$5,621.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40009111
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,902.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,091.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,810.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,232.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,902.05
|
| Rate for Payer: Group Health Inc Commercial |
$2,810.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,967.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,810.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,810.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,653.65
|
|
|
TRICHLOROACETIC ACID 80% W/V SOLUTION
|
Facility
OP
|
$76.00
|
|
| Hospital Charge Code |
41652259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.00
|
| Rate for Payer: Aetna Government |
$38.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$60.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.68
|
| Rate for Payer: Group Health Inc Commercial |
$38.00
|
| Rate for Payer: Group Health Inc Medicare |
$26.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49.40
|
|
