|
TREAT ULNAR FRACT W/O MANIP
|
Facility
|
IP
|
$653.13
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
30105777
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$272.71
|
|
|
TREAT ULNAR FRACT W/O MANIP
|
Facility
|
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 25530
|
| Hospital Charge Code |
30105777
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.71
|
| Rate for Payer: Aetna Government |
$272.71
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$272.71
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.71
|
| 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 |
$272.71
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.71
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$218.17
|
| Rate for Payer: Wellcare Medicare |
$259.07
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$645.82
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
30307890
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.17 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.71
|
| Rate for Payer: Aetna Government |
$272.71
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.71
|
| 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 |
$272.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.71
|
| 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 |
$322.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.80
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$218.17
|
| Rate for Payer: Wellcare Medicare |
$259.07
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
OP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 25635
|
| Hospital Charge Code |
30300155
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.61
|
| 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 |
$1,858.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,654.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,654.16
|
| 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 |
$2,052.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,579.82
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,858.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,486.89
|
| Rate for Payer: Wellcare Medicare |
$1,765.68
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$645.82
|
|
|
Service Code
|
HCPCS 25630
|
| Hospital Charge Code |
30307890
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$272.71
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 25635
|
| Hospital Charge Code |
30300155
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,858.61
|
|
|
TREAT WRSIT FX W/MANIP
|
Facility
|
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
30102925
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.71
|
| Rate for Payer: Aetna Government |
$272.71
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$272.71
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.71
|
| 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 |
$272.71
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.71
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$218.17
|
| Rate for Payer: Wellcare Medicare |
$259.07
|
|
|
TREAT WRSIT FX W/MANIP
|
Facility
|
IP
|
$653.13
|
|
|
Service Code
|
HCPCS 25680
|
| Hospital Charge Code |
30102925
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$272.71
|
|
|
TREMELIMUMAB-ACTL 300 MG/15ML IV SOLN [188673]
|
Facility
|
IP
|
$3,120.00
|
|
|
Service Code
|
NDC 00310453530
|
| Hospital Charge Code |
00310453530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.00 |
| Max. Negotiated Rate |
$1,560.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,560.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,560.00
|
|
|
TREMELIMUMAB-ACTL 300 MG/15ML IV SOLN [188673]
|
Facility
|
OP
|
$3,120.00
|
|
|
Service Code
|
NDC 00310453530
|
| Hospital Charge Code |
00310453530
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,092.00 |
| Max. Negotiated Rate |
$3,276.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,716.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,560.00
|
| Rate for Payer: Aetna Government |
$1,560.00
|
| Rate for Payer: Brighton Health Commercial |
$1,872.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,560.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,794.00
|
| Rate for Payer: EmblemHealth Commercial |
$1,560.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,276.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,560.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,092.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,560.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,560.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,028.00
|
|
|
TRG GENE REARRANGE ANAL
|
Facility
|
OP
|
$503.75
|
|
|
Service Code
|
HCPCS 81342
|
| Hospital Charge Code |
30305428
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$277.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$201.50
|
| Rate for Payer: Aetna Government |
$201.50
|
| Rate for Payer: Brighton Health Commercial |
$201.50
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Cash Price |
$201.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$201.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$403.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$342.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$201.50
|
| Rate for Payer: EmblemHealth Commercial |
$201.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$171.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$179.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$201.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$179.34
|
| Rate for Payer: Group Health Inc Commercial |
$201.50
|
| Rate for Payer: Group Health Inc Medicare |
$201.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.50
|
| Rate for Payer: Healthfirst QHP |
$201.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$201.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$201.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$161.20
|
| Rate for Payer: Wellcare Medicare |
$181.35
|
|
|
TRG GENE REARRANGE ANAL
|
Facility
|
IP
|
$503.75
|
|
|
Service Code
|
HCPCS 81342
|
| Hospital Charge Code |
30305428
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$201.50
|
|
|
TRH
|
Facility
|
IP
|
$168.03
|
|
|
Service Code
|
HCPCS 80439
|
| Hospital Charge Code |
30301316
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$67.21
|
|
|
TRH
|
Facility
|
OP
|
$168.03
|
|
|
Service Code
|
HCPCS 80439
|
| Hospital Charge Code |
30301316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.77 |
| Max. Negotiated Rate |
$126.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.21
|
| Rate for Payer: Aetna Government |
$67.21
|
| Rate for Payer: Brighton Health Commercial |
$126.02
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Cash Price |
$67.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$67.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$106.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$90.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$67.21
|
| Rate for Payer: EmblemHealth Commercial |
$67.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$57.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$59.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$67.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$59.82
|
| Rate for Payer: Group Health Inc Commercial |
$67.21
|
| Rate for Payer: Group Health Inc Medicare |
$67.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$67.21
|
| Rate for Payer: Healthfirst QHP |
$67.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$67.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.77
|
| Rate for Payer: Wellcare Medicare |
$60.49
|
|
|
TRIADYNE II BED
|
Facility
|
OP
|
$200.00
|
|
| Hospital Charge Code |
40209303
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.00
|
| Rate for Payer: Aetna Government |
$100.00
|
| Rate for Payer: Brighton Health Commercial |
$150.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
|
|
TRIAGE FEE
|
Facility
|
OP
|
$712.75
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
30103301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.14 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102.67
|
| Rate for Payer: Aetna Government |
$102.67
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$102.67
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Cash Price |
$102.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$747.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$635.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$102.67
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.38
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$356.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$102.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$102.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.14
|
| Rate for Payer: Wellcare Medicare |
$97.54
|
|
|
TRIAGE FEE
|
Facility
|
IP
|
$712.75
|
|
|
Service Code
|
HCPCS 99281
|
| Hospital Charge Code |
30103301
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$102.67
|
|
|
TRIAMCINOLONE 0.025% CREAM 15 GRAMS
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
41650418
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
TRIAMCINOLONE 0.025% CREAM 15 GRAMS
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
41640418
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
TRIAMCINOLONE 0.025% CREAM 80 GRAMS
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41650879
|
|
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
|
|
|
TRIAMCINOLONE 0.025% CREAM 80 GRAMS
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41640879
|
|
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
|
|
|
TRIAMCINOLONE 0.1% CREAM 15G
|
Facility
|
OP
|
$2.85
|
|
| Hospital Charge Code |
41640157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.42
|
| Rate for Payer: Aetna Government |
$1.42
|
| Rate for Payer: Brighton Health Commercial |
$2.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.94
|
| Rate for Payer: Group Health Inc Commercial |
$1.42
|
| Rate for Payer: Group Health Inc Medicare |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.85
|
|
|
TRIAMCINOLONE 0.1% CREAM 15G
|
Facility
|
OP
|
$2.85
|
|
| Hospital Charge Code |
41650157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.42
|
| Rate for Payer: Aetna Government |
$1.42
|
| Rate for Payer: Brighton Health Commercial |
$2.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.94
|
| Rate for Payer: Group Health Inc Commercial |
$1.42
|
| Rate for Payer: Group Health Inc Medicare |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.85
|
|
|
TRIAMCINOLONE 0.1% CREAM 80 GRAMS
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
41640166
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.75
|
|
|
TRIAMCINOLONE 0.1% CREAM 80 GRAMS
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
41650166
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.75
|
|
