THERAPY FOR CONTOUR DEFECTS >10CC
|
Facility
|
IP
|
$967.73
|
|
Service Code
|
HCPCS 11954
|
Hospital Charge Code |
42201700
|
Hospital Revenue Code
|
361
|
Rate for Payer: Cash Price |
$726.29
|
|
THERAPY FOR USE OF SGD
|
Facility
|
OP
|
$315.98
|
|
Service Code
|
HCPCS 92609
|
Hospital Charge Code |
41905003
|
Hospital Revenue Code
|
440
|
Min. Negotiated Rate |
$55.00 |
Max. Negotiated Rate |
$13,928.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$173.79
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.24
|
Rate for Payer: Aetna Government |
$95.24
|
Rate for Payer: Amida Care Medicaid |
$139.28
|
Rate for Payer: Brighton Health Commercial |
$182.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13,928.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$139.28
|
Rate for Payer: Fidelis Essential Plan QHP |
$139.28
|
Rate for Payer: Fidelis Qualified Health Plan |
$146.24
|
Rate for Payer: Group Health Inc Commercial |
$157.99
|
Rate for Payer: Group Health Inc Medicare |
$120.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.28
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$157.99
|
Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$139.28
|
Rate for Payer: Healthfirst Essential Plan |
$313.38
|
Rate for Payer: Healthfirst QHP |
$139.28
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$139.28
|
Rate for Payer: SOMOS Essential |
$313.38
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$139.28
|
Rate for Payer: Wellcare Medicare |
$55.00
|
|
THERASKIN PER SQ CM
|
Facility
|
IP
|
$44.60
|
|
Service Code
|
HCPCS Q4121
|
Hospital Charge Code |
30305417
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$22.30 |
Max. Negotiated Rate |
$22.30 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$22.30
|
|
THERASKIN PER SQ CM
|
Facility
|
OP
|
$44.60
|
|
Service Code
|
HCPCS Q4121
|
Hospital Charge Code |
30305417
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$15.61 |
Max. Negotiated Rate |
$48.90 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.53
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.84
|
Rate for Payer: Aetna Government |
$43.84
|
Rate for Payer: Brighton Health Commercial |
$26.76
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.30
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.64
|
Rate for Payer: Group Health Inc Commercial |
$22.30
|
Rate for Payer: Group Health Inc Medicare |
$15.61
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.30
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$22.30
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.90
|
Rate for Payer: SOMOS Essential |
$48.90
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.99
|
|
THERASKIN,PER SQ CM
|
Facility
|
IP
|
$535.00
|
|
Service Code
|
HCPCS Q4121
|
Hospital Charge Code |
42501058
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$267.50 |
Max. Negotiated Rate |
$267.50 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$267.50
|
|
THERASKIN,PER SQ CM
|
Facility
|
OP
|
$535.00
|
|
Service Code
|
HCPCS Q4121
|
Hospital Charge Code |
42501058
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$43.84 |
Max. Negotiated Rate |
$347.75 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$294.25
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.84
|
Rate for Payer: Aetna Government |
$43.84
|
Rate for Payer: Brighton Health Commercial |
$321.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$267.50
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$307.62
|
Rate for Payer: Group Health Inc Commercial |
$267.50
|
Rate for Payer: Group Health Inc Medicare |
$187.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$267.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$267.50
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$48.90
|
Rate for Payer: SOMOS Essential |
$48.90
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$347.75
|
|
THER/DIAG CONCURRENT INF
|
Facility
|
OP
|
$71.45
|
|
Service Code
|
HCPCS 96368
|
Hospital Charge Code |
30305934
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$18.06 |
Max. Negotiated Rate |
$57.16 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.06
|
Rate for Payer: Aetna Government |
$18.06
|
Rate for Payer: Brighton Health Commercial |
$53.59
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.16
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.59
|
Rate for Payer: Group Health Inc Commercial |
$35.72
|
Rate for Payer: Group Health Inc Medicare |
$25.01
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.72
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$35.72
|
|
THER/DIAG CONCURRENT INF
|
Facility
|
OP
|
$71.45
|
|
Service Code
|
HCPCS 96368
|
Hospital Charge Code |
30105934
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$18.06 |
Max. Negotiated Rate |
$57.16 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.06
|
Rate for Payer: Aetna Government |
$18.06
|
Rate for Payer: Brighton Health Commercial |
$53.59
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.16
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.59
|
Rate for Payer: Group Health Inc Commercial |
$35.72
|
Rate for Payer: Group Health Inc Medicare |
$25.01
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.72
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$35.72
|
|
THER FX NASAL INF TURBINATE.
|
Facility
|
IP
|
$7,933.18
|
|
Service Code
|
HCPCS 30930
|
Hospital Charge Code |
40109383
|
Hospital Revenue Code
|
360
|
Rate for Payer: Cash Price |
$3,723.23
|
|
THER FX NASAL INF TURBINATE.
|
Facility
|
OP
|
$7,933.18
|
|
Service Code
|
HCPCS 30930
|
Hospital Charge Code |
40109383
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$1,505.00 |
Max. Negotiated Rate |
$5,949.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
Rate for Payer: Aetna Government |
$3,723.23
|
Rate for Payer: Brighton Health Commercial |
$5,949.88
|
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 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 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
|
|
THERICS PUTTY BN V FILLER 1CC
|
Facility
|
IP
|
$500.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205441
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$250.00 |
Max. Negotiated Rate |
$250.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
|
THERICS PUTTY BN V FILLER 1CC
|
Facility
|
OP
|
$500.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40205441
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$525.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$300.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$250.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$287.50
|
Rate for Payer: EmblemHealth Commercial |
$250.00
|
Rate for Payer: Fidelis Medicare Advantage |
$525.00
|
Rate for Payer: Group Health Inc Commercial |
$250.00
|
Rate for Payer: Group Health Inc Medicare |
$175.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$325.00
|
|
THERIGRAFT PUTTY 5CC
|
Facility
|
OP
|
$1,600.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202062
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$134.20 |
Max. Negotiated Rate |
$1,680.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$880.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
Rate for Payer: Aetna Government |
$134.20
|
Rate for Payer: Brighton Health Commercial |
$960.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$800.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$920.00
|
Rate for Payer: EmblemHealth Commercial |
$800.00
|
Rate for Payer: Fidelis Medicare Advantage |
$1,680.00
|
Rate for Payer: Group Health Inc Commercial |
$800.00
|
Rate for Payer: Group Health Inc Medicare |
$560.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$800.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$800.00
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,040.00
|
|
THERIGRAFT PUTTY 5CC
|
Facility
|
IP
|
$1,600.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
40202062
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$800.00 |
Max. Negotiated Rate |
$800.00 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$800.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$800.00
|
|
THER INJECTION CARP TUNNEL
|
Facility
|
OP
|
$792.83
|
|
Service Code
|
HCPCS 20526
|
Hospital Charge Code |
40009447
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$274.01 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
Rate for Payer: Aetna Government |
$342.51
|
Rate for Payer: Brighton Health Commercial |
$594.62
|
Rate for Payer: Cash Price |
$342.51
|
Rate for Payer: Cash Price |
$342.51
|
Rate for Payer: Cash Price |
$342.51
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
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 |
$342.51
|
Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
Rate for Payer: Group Health Inc Commercial |
$342.51
|
Rate for Payer: Group Health Inc Medicare |
$342.51
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.42
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
Rate for Payer: Healthfirst QHP |
$342.51
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
Rate for Payer: Wellcare Medicare |
$325.38
|
|
THER INJECTION CARP TUNNEL
|
Facility
|
IP
|
$792.83
|
|
Service Code
|
HCPCS 20526
|
Hospital Charge Code |
40009447
|
Hospital Revenue Code
|
360
|
Rate for Payer: Cash Price |
$342.51
|
|
THERMA-GUARD PLUS
|
Facility
|
OP
|
$522.22
|
|
Hospital Charge Code |
64902875
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$182.78 |
Max. Negotiated Rate |
$417.78 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$287.22
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$261.11
|
Rate for Payer: Aetna Government |
$261.11
|
Rate for Payer: Brighton Health Commercial |
$391.66
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$417.78
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$355.11
|
Rate for Payer: Group Health Inc Commercial |
$261.11
|
Rate for Payer: Group Health Inc Medicare |
$182.78
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$261.11
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$261.11
|
|
THERMOMETER TEMPA DOT ORAL
|
Facility
|
OP
|
$0.18
|
|
Hospital Charge Code |
64901108
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$0.06 |
Max. Negotiated Rate |
$0.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
Rate for Payer: Aetna Government |
$0.09
|
Rate for Payer: Brighton Health Commercial |
$0.14
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
Rate for Payer: Group Health Inc Commercial |
$0.09
|
Rate for Payer: Group Health Inc Medicare |
$0.06
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
|
THERMOMETER TEMPA DOT RECTAL
|
Facility
|
OP
|
$0.34
|
|
Hospital Charge Code |
64901110
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.27 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.17
|
Rate for Payer: Aetna Government |
$0.17
|
Rate for Payer: Brighton Health Commercial |
$0.26
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.27
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.23
|
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
|
|
THER/PROPH/DIAG ING IA
|
Facility
|
IP
|
$556.50
|
|
Service Code
|
HCPCS 96373
|
Hospital Charge Code |
30303090
|
Hospital Revenue Code
|
510
|
Rate for Payer: Cash Price |
$247.87
|
|
THER/PROPH/DIAG ING IA
|
Facility
|
OP
|
$556.50
|
|
Service Code
|
HCPCS 96373
|
Hospital Charge Code |
30303090
|
Hospital Revenue Code
|
510
|
Min. Negotiated Rate |
$173.89 |
Max. Negotiated Rate |
$306.08 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
Rate for Payer: Aetna Government |
$247.87
|
Rate for Payer: Brighton Health Commercial |
$233.00
|
Rate for Payer: Cash Price |
$247.87
|
Rate for Payer: Cash Price |
$247.87
|
Rate for Payer: Cash Price |
$247.87
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
Rate for Payer: Elderplan Medicare Advantage |
$247.87
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
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 |
$278.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
Rate for Payer: Healthfirst QHP |
$247.87
|
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.87
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
Rate for Payer: Wellcare Medicare |
$235.48
|
|
THER/PROPH/DIAG IV INF, INT
|
Facility
|
OP
|
$556.50
|
|
Service Code
|
HCPCS 96365
|
Hospital Charge Code |
30103083
|
Hospital Revenue Code
|
260
|
Min. Negotiated Rate |
$198.30 |
Max. Negotiated Rate |
$445.20 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
Rate for Payer: Aetna Government |
$247.87
|
Rate for Payer: Brighton Health Commercial |
$417.38
|
Rate for Payer: Cash Price |
$247.87
|
Rate for Payer: Cash Price |
$247.87
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$445.20
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.42
|
Rate for Payer: Elderplan Medicare Advantage |
$247.87
|
Rate for Payer: EmblemHealth Commercial |
$247.87
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
Rate for Payer: Group Health Inc Commercial |
$247.87
|
Rate for Payer: Group Health Inc Medicare |
$247.87
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
Rate for Payer: Healthfirst QHP |
$247.87
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
Rate for Payer: Wellcare Medicare |
$235.48
|
|
THER/PROPH/DIAG IV INF, INT
|
Facility
|
IP
|
$556.50
|
|
Service Code
|
HCPCS 96365
|
Hospital Charge Code |
30103083
|
Hospital Revenue Code
|
260
|
Rate for Payer: Cash Price |
$247.87
|
|
THIABENDAZOLE 500 MG CHEW TAB
|
Facility
|
OP
|
$3.00
|
|
Hospital Charge Code |
41651522
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.05 |
Max. Negotiated Rate |
$2.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
Rate for Payer: Aetna Government |
$1.50
|
Rate for Payer: Brighton Health Commercial |
$2.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
Rate for Payer: Group Health Inc Commercial |
$1.50
|
Rate for Payer: Group Health Inc Medicare |
$1.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
THIABENDAZOLE 500 MG CHEW TAB
|
Facility
|
OP
|
$3.00
|
|
Hospital Charge Code |
41641522
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$1.05 |
Max. Negotiated Rate |
$2.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
Rate for Payer: Aetna Government |
$1.50
|
Rate for Payer: Brighton Health Commercial |
$2.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
Rate for Payer: Group Health Inc Commercial |
$1.50
|
Rate for Payer: Group Health Inc Medicare |
$1.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|