|
BUPRENORPHINE, URINE
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 80348
|
| Hospital Charge Code |
40609008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.60
|
| Rate for Payer: Group Health Inc Commercial |
$22.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
|
|
BUPRENORPHNE DISPENSE BDL WK1,3,4
|
Facility
OP
|
$260.59
|
|
|
Service Code
|
HCPCS G2068
|
| Hospital Charge Code |
30400265
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$91.21 |
| Max. Negotiated Rate |
$284.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.32
|
| 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 |
$208.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$177.20
|
| Rate for Payer: Group Health Inc Commercial |
$130.30
|
| Rate for Payer: Group Health Inc Medicare |
$91.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.30
|
|
|
BUPROPION 100 MG TAB
|
Facility
OP
|
$0.36
|
|
| Hospital Charge Code |
41643233
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
BUPROPION 100 MG TAB
|
Facility
OP
|
$0.36
|
|
| Hospital Charge Code |
41653233
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
BUPROPION 75 MG TAB
|
Facility
OP
|
$0.33
|
|
| Hospital Charge Code |
41653232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna Government |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.22
|
| Rate for Payer: Group Health Inc Commercial |
$0.17
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.21
|
|
|
BUPROPION 75 MG TAB
|
Facility
OP
|
$0.33
|
|
| Hospital Charge Code |
41643232
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna Government |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.22
|
| Rate for Payer: Group Health Inc Commercial |
$0.17
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.21
|
|
|
BUR BARREL 6 FLUTE 4.0MM
|
Facility
OP
|
$100.06
|
|
| Hospital Charge Code |
64904974
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$80.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.03
|
| Rate for Payer: Aetna Government |
$50.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.04
|
| Rate for Payer: Group Health Inc Commercial |
$50.03
|
| Rate for Payer: Group Health Inc Medicare |
$35.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.03
|
|
|
BUR BARREL 6 FLUTE 5.0MM
|
Facility
OP
|
$145.10
|
|
| Hospital Charge Code |
64904976
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.78 |
| Max. Negotiated Rate |
$116.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.55
|
| Rate for Payer: Aetna Government |
$72.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$116.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.67
|
| Rate for Payer: Group Health Inc Commercial |
$72.55
|
| Rate for Payer: Group Health Inc Medicare |
$50.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.55
|
|
|
BUR BARREL 6 FLUTE 5.5.MM
|
Facility
OP
|
$20.00
|
|
| Hospital Charge Code |
64904978
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.00
|
| Rate for Payer: Aetna Government |
$10.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| Rate for Payer: Group Health Inc Commercial |
$10.00
|
| Rate for Payer: Group Health Inc Medicare |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
|
|
BUR BARREL SURG 6 5MM RPRC
|
Facility
OP
|
$54.35
|
|
| Hospital Charge Code |
64903594
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$43.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.18
|
| Rate for Payer: Aetna Government |
$27.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.96
|
| Rate for Payer: Group Health Inc Commercial |
$27.18
|
| Rate for Payer: Group Health Inc Medicare |
$19.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.18
|
|
|
BUR CARBIDE 2.1MM SIDE CUT
|
Facility
OP
|
$31.03
|
|
| Hospital Charge Code |
64904314
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$24.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.52
|
| Rate for Payer: Aetna Government |
$15.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.10
|
| Rate for Payer: Group Health Inc Commercial |
$15.52
|
| Rate for Payer: Group Health Inc Medicare |
$10.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.52
|
|
|
BUR DIAMOND AM-8D 2.9MMD/5.8L
|
Facility
OP
|
$515.00
|
|
| Hospital Charge Code |
64904782
|
|
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
|
|
|
BUR DIAMOND G4-360D
|
Facility
OP
|
$320.00
|
|
| Hospital Charge Code |
64906848
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$160.00
|
| Rate for Payer: Aetna Government |
$160.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$256.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$217.60
|
| 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
|
|
|
BUR DIAMOND M-340D
|
Facility
OP
|
$507.50
|
|
| Hospital Charge Code |
64904788
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$177.62 |
| Max. Negotiated Rate |
$406.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$279.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$253.75
|
| Rate for Payer: Aetna Government |
$253.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$406.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$345.10
|
| Rate for Payer: Group Health Inc Commercial |
$253.75
|
| Rate for Payer: Group Health Inc Medicare |
$177.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$253.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$253.75
|
|
|
BUR DIAMOND M-8D 2.9MMD/3.8L
|
Facility
OP
|
$465.00
|
|
| Hospital Charge Code |
64904785
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$162.75 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$255.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$232.50
|
| Rate for Payer: Aetna Government |
$232.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$372.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$316.20
|
| Rate for Payer: Group Health Inc Commercial |
$232.50
|
| Rate for Payer: Group Health Inc Medicare |
$162.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$232.50
|
|
|
BURENORPHINE+NALOXONE 8MG-2MG
|
Facility
IP
|
$14.48
|
|
| Hospital Charge Code |
41656001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.24
|
|
|
BURENORPHINE+NALOXONE 8MG-2MG
|
Facility
OP
|
$14.48
|
|
| Hospital Charge Code |
41656001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.24
|
| Rate for Payer: Aetna Government |
$7.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.33
|
| Rate for Payer: Group Health Inc Commercial |
$7.24
|
| Rate for Payer: Group Health Inc Medicare |
$5.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.41
|
|
|
BURETROL SET
|
Facility
OP
|
$16.31
|
|
| Hospital Charge Code |
40509796
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$13.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.16
|
| Rate for Payer: Aetna Government |
$8.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.09
|
| Rate for Payer: Group Health Inc Commercial |
$8.16
|
| Rate for Payer: Group Health Inc Medicare |
$5.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.16
|
|
|
BUR FLAME 6.0 X 48MM BRASSELER
|
Facility
OP
|
$42.63
|
|
| Hospital Charge Code |
64904115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.92 |
| Max. Negotiated Rate |
$34.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.32
|
| Rate for Payer: Aetna Government |
$21.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.99
|
| Rate for Payer: Group Health Inc Commercial |
$21.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.32
|
|
|
BUR FORMULA BAR 12F RR 4MM
|
Facility
OP
|
$54.35
|
|
| Hospital Charge Code |
64906052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.02 |
| Max. Negotiated Rate |
$43.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.18
|
| Rate for Payer: Aetna Government |
$27.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.96
|
| Rate for Payer: Group Health Inc Commercial |
$27.18
|
| Rate for Payer: Group Health Inc Medicare |
$19.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.18
|
|
|
BUR FORMULA BAR 6 F RR 4MM
|
Facility
OP
|
$271.75
|
|
| Hospital Charge Code |
64906051
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$95.11 |
| Max. Negotiated Rate |
$217.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$149.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$135.88
|
| Rate for Payer: Aetna Government |
$135.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.79
|
| Rate for Payer: Group Health Inc Commercial |
$135.88
|
| Rate for Payer: Group Health Inc Medicare |
$95.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.88
|
|
|
BUR HILAN ROSEN II 2.3MM
|
Facility
OP
|
$137.32
|
|
| Hospital Charge Code |
40200474
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$48.06 |
| Max. Negotiated Rate |
$109.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$75.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$68.66
|
| Rate for Payer: Aetna Government |
$68.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$109.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$93.38
|
| Rate for Payer: Group Health Inc Commercial |
$68.66
|
| Rate for Payer: Group Health Inc Medicare |
$48.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$68.66
|
|
|
BUR JOIN
|
Facility
OP
|
$168.08
|
|
| Hospital Charge Code |
64907321
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.83 |
| Max. Negotiated Rate |
$134.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$84.04
|
| Rate for Payer: Aetna Government |
$84.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$134.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.29
|
| Rate for Payer: Group Health Inc Commercial |
$84.04
|
| Rate for Payer: Group Health Inc Medicare |
$58.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.04
|
|
|
BUR MATCH HD FLUTE 3MMX10CM
|
Facility
OP
|
$87.50
|
|
| Hospital Charge Code |
64904915
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.75
|
| Rate for Payer: Aetna Government |
$43.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$70.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.50
|
| Rate for Payer: Group Health Inc Commercial |
$43.75
|
| Rate for Payer: Group Health Inc Medicare |
$30.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.75
|
|
|
BUR MATCH HEAD T14 2.5MM HEAD
|
Facility
OP
|
$87.50
|
|
| Hospital Charge Code |
64904913
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.75
|
| Rate for Payer: Aetna Government |
$43.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$70.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.50
|
| Rate for Payer: Group Health Inc Commercial |
$43.75
|
| Rate for Payer: Group Health Inc Medicare |
$30.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.75
|
|
