|
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
|
|
|
TRICHOMONAS CULTURE
|
Facility
OP
|
$16.58
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
40619851
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.63
|
| Rate for Payer: Aetna Government |
$6.63
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Cash Price |
$6.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.63
|
| Rate for Payer: EmblemHealth Commercial |
$6.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.90
|
| Rate for Payer: Group Health Inc Commercial |
$6.63
|
| Rate for Payer: Group Health Inc Medicare |
$6.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.63
|
| Rate for Payer: Healthfirst QHP |
$6.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.30
|
| Rate for Payer: Wellcare Medicare |
$5.97
|
|
|
TRICH VAG BY NAA
|
Facility
OP
|
$87.50
|
|
|
Service Code
|
HCPCS 87661
|
| Hospital Charge Code |
40619759
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$70.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
TRICUT BLADE
|
Facility
OP
|
$515.00
|
|
| Hospital Charge Code |
64905965
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$283.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$257.50
|
| Rate for Payer: Aetna Government |
$257.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$412.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$350.20
|
| Rate for Payer: Group Health Inc Commercial |
$257.50
|
| Rate for Payer: Group Health Inc Medicare |
$180.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.50
|
|
|
TRIDENT 0 POLYETHYLENE INSERT36MM
|
Facility
IP
|
$4,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,295.00 |
| Max. Negotiated Rate |
$2,295.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,295.00
|
|
|
TRIDENT 0 POLYETHYLENE INSERT36MM
|
Facility
OP
|
$4,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205023
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,819.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,524.50
|
| 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 |
$2,295.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,639.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,819.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,295.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,606.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,295.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,983.50
|
|
|
TRIDENT 10 POLY INSERT 36MM
|
Facility
OP
|
$4,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,819.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,524.50
|
| 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 |
$2,295.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,639.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,819.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,295.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,606.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,295.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,983.50
|
|
|
TRIDENT 10 POLY INSERT 36MM
|
Facility
IP
|
$4,590.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,295.00 |
| Max. Negotiated Rate |
$2,295.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,295.00
|
|
|
TRIDENT II TRI MULTIHOLE
|
Facility
OP
|
$12,084.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$12,688.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,646.41
|
| 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 |
$6,042.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,948.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,688.60
|
| Rate for Payer: Group Health Inc Commercial |
$6,042.19
|
| Rate for Payer: Group Health Inc Medicare |
$4,229.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,042.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,042.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,854.85
|
|
|
TRIDENT II TRI MULTIHOLE
|
Facility
IP
|
$12,084.38
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907273
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,042.19 |
| Max. Negotiated Rate |
$6,042.19 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,042.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,042.19
|
|
|
TRIDENT TRITANIUM HEMI SHELL 54MM
|
Facility
IP
|
$8,320.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,160.00 |
| Max. Negotiated Rate |
$4,160.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,160.00
|
|
|
TRIDENT TRITANIUM HEMI SHELL 54MM
|
Facility
OP
|
$8,320.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$8,736.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,576.00
|
| 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 |
$4,160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,784.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,736.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,160.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,912.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,160.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,408.00
|
|
|
TRIDENT TRITANIUM HEMI SHELL 56MM
|
Facility
OP
|
$8,320.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$8,736.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,576.00
|
| 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 |
$4,160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,784.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,736.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,160.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,912.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,160.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,408.00
|
|
|
TRIDENT TRITANIUM HEMI SHELL 56MM
|
Facility
IP
|
$8,320.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,160.00 |
| Max. Negotiated Rate |
$4,160.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,160.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,160.00
|
|
|
TRIFLUOPERAZINE 10 MG TAB
|
Facility
OP
|
$1.29
|
|
| Hospital Charge Code |
41654114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.65
|
| Rate for Payer: Aetna Government |
$0.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.88
|
| Rate for Payer: Group Health Inc Commercial |
$0.65
|
| Rate for Payer: Group Health Inc Medicare |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.84
|
|
|
TRIFLUOPERAZINE 10 MG TAB
|
Facility
OP
|
$1.29
|
|
| Hospital Charge Code |
41644114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.65
|
| Rate for Payer: Aetna Government |
$0.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.88
|
| Rate for Payer: Group Health Inc Commercial |
$0.65
|
| Rate for Payer: Group Health Inc Medicare |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.84
|
|
|
TRIFLUOPERAZINE 1 MG TAB
|
Facility
OP
|
$0.48
|
|
| Hospital Charge Code |
41654945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
TRIFLUOPERAZINE 1 MG TAB
|
Facility
OP
|
$0.48
|
|
| Hospital Charge Code |
41644945
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.24
|
| Rate for Payer: Aetna Government |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
|
|
TRIFLUOPERAZINE 2 MG TAB
|
Facility
OP
|
$0.68
|
|
| Hospital Charge Code |
41644112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.44
|
|
|
TRIFLUOPERAZINE 2 MG TAB
|
Facility
OP
|
$0.68
|
|
| Hospital Charge Code |
41654112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
| Rate for Payer: Aetna Government |
$0.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.34
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.44
|
|
|
TRIFLUOPERAZINE 5 MG TAB
|
Facility
OP
|
$0.89
|
|
| Hospital Charge Code |
41644113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.61
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.58
|
|
|
TRIFLUOPERAZINE 5 MG TAB
|
Facility
OP
|
$0.89
|
|
| Hospital Charge Code |
41654113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.61
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.58
|
|
|
TRIFLURIDINE 1% OPHTHALMIC SOLN
|
Facility
OP
|
$243.82
|
|
| Hospital Charge Code |
41643372
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.34 |
| Max. Negotiated Rate |
$195.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$121.91
|
| Rate for Payer: Aetna Government |
$121.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$195.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$165.80
|
| Rate for Payer: Group Health Inc Commercial |
$121.91
|
| Rate for Payer: Group Health Inc Medicare |
$85.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.48
|
|
|
TRIFLURIDINE 1% OPHTHALMIC SOLN
|
Facility
OP
|
$243.82
|
|
| Hospital Charge Code |
41653372
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.34 |
| Max. Negotiated Rate |
$195.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$121.91
|
| Rate for Payer: Aetna Government |
$121.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$195.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$165.80
|
| Rate for Payer: Group Health Inc Commercial |
$121.91
|
| Rate for Payer: Group Health Inc Medicare |
$85.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$158.48
|
|
|
TRIGEMINAL DIVISION BLOCK ANESTHE
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
HCPCS D9212
|
| Hospital Charge Code |
42302295
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.19
|
| Rate for Payer: Aetna Government |
$18.19
|
| 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 |
$59.00
|
| Rate for Payer: Group Health Inc Medicare |
$41.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.00
|
|
