|
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: Brighton Health Commercial |
$88.50
|
| 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
|
|
|
TRIGEMINAL NERVE
|
Facility
|
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64600
|
| Hospital Charge Code |
30305724
|
|
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 |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
| 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 |
$1,054.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| 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 |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
TRIGEMINAL NERVE
|
Facility
|
IP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64600
|
| Hospital Charge Code |
30305724
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,054.06
|
|
|
TRIGLYCERIDES FLUID
|
Facility
|
IP
|
$14.35
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
40609738
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$5.74
|
|
|
TRIGLYCERIDES FLUID
|
Facility
|
OP
|
$14.35
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
40609738
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$10.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.74
|
| Rate for Payer: Aetna Government |
$5.74
|
| Rate for Payer: Brighton Health Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.74
|
| Rate for Payer: EmblemHealth Commercial |
$5.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.11
|
| Rate for Payer: Group Health Inc Commercial |
$5.74
|
| Rate for Payer: Group Health Inc Medicare |
$5.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.74
|
| Rate for Payer: Healthfirst QHP |
$5.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.59
|
| Rate for Payer: Wellcare Medicare |
$5.17
|
|
|
TRIGLYCERIDES QUANTITATION
|
Facility
|
IP
|
$14.35
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
40602485
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$5.74
|
|
|
TRIGLYCERIDES QUANTITATION
|
Facility
|
OP
|
$14.35
|
|
|
Service Code
|
HCPCS 84478
|
| Hospital Charge Code |
40602485
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$10.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.74
|
| Rate for Payer: Aetna Government |
$5.74
|
| Rate for Payer: Brighton Health Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.74
|
| Rate for Payer: EmblemHealth Commercial |
$5.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.11
|
| Rate for Payer: Group Health Inc Commercial |
$5.74
|
| Rate for Payer: Group Health Inc Medicare |
$5.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.74
|
| Rate for Payer: Healthfirst QHP |
$5.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.59
|
| Rate for Payer: Wellcare Medicare |
$5.17
|
|
|
TRIHEXYPHENIDYL 2 MG/5 ML ELIXIR
|
Facility
|
OP
|
$0.05
|
|
| Hospital Charge Code |
41653617
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
TRIHEXYPHENIDYL 2 MG/5 ML ELIXIR
|
Facility
|
OP
|
$0.05
|
|
| Hospital Charge Code |
41643617
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
TRIHEXYPHENIDYL 2 MG TAB
|
Facility
|
OP
|
$0.39
|
|
| Hospital Charge Code |
41653458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
TRIHEXYPHENIDYL 2 MG TAB
|
Facility
|
OP
|
$0.39
|
|
| Hospital Charge Code |
41643458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
TRIHEXYPHENIDYL 5 MG TAB
|
Facility
|
OP
|
$0.97
|
|
| Hospital Charge Code |
41653459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.49
|
| Rate for Payer: Aetna Government |
$0.49
|
| Rate for Payer: Brighton Health Commercial |
$0.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.66
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.63
|
|
|
TRIHEXYPHENIDYL 5 MG TAB
|
Facility
|
OP
|
$0.97
|
|
| Hospital Charge Code |
41643459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.49
|
| Rate for Payer: Aetna Government |
$0.49
|
| Rate for Payer: Brighton Health Commercial |
$0.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.66
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.63
|
|
|
TRIHEXYPHENIDYL HCL 0.4 MG/ML PO SOLN [169097]
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 00121065816
|
| Hospital Charge Code |
00121065816
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
TRIHEXYPHENIDYL HCL 2 MG PO TABS [8166]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 00591533501
|
| Hospital Charge Code |
00591533501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.15 |
| 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 |
$0.15
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
TRIHEXYPHENIDYL HCL 2 MG PO TABS [8166]
|
Facility
|
OP
|
$0.37
|
|
|
Service Code
|
NDC 70954021210
|
| Hospital Charge Code |
70954021210
|
|
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: Brighton Health Commercial |
$0.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.25
|
| 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 |
$0.24
|
|
|
TRIHEXYPHENIDYL HCL 5 MG PO TABS [8167]
|
Facility
|
OP
|
$0.34
|
|
|
Service Code
|
NDC 00591533710
|
| Hospital Charge Code |
00591533710
|
|
Hospital Revenue Code
|
250
|
| 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
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.22
|
|
|
TRIIODOTHYRONINE,FREE,SERUM
|
Facility
|
IP
|
$42.35
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
40609126
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.94
|
|
|
TRIIODOTHYRONINE,FREE,SERUM
|
Facility
|
OP
|
$42.35
|
|
|
Service Code
|
HCPCS 84481
|
| Hospital Charge Code |
40609126
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$31.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.94
|
| Rate for Payer: Aetna Government |
$16.94
|
| Rate for Payer: Brighton Health Commercial |
$31.76
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.94
|
| Rate for Payer: EmblemHealth Commercial |
$16.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.08
|
| Rate for Payer: Group Health Inc Commercial |
$16.94
|
| Rate for Payer: Group Health Inc Medicare |
$16.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.94
|
| Rate for Payer: Healthfirst QHP |
$16.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.55
|
| Rate for Payer: Wellcare Medicare |
$15.25
|
|
|
TRIM NAIL(S)
|
Facility
|
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
30300162
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.59 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| 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 |
$70.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| 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 |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
TRIM NAIL(S)
|
Facility
|
IP
|
$166.60
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
30300162
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
TRIM NAILS
|
Facility
|
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
42500144
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.59 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| 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 |
$70.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| 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 |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
TRIM NAILS
|
Facility
|
IP
|
$166.60
|
|
|
Service Code
|
HCPCS 11719
|
| Hospital Charge Code |
42500144
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
TRIM NAIL(S) DYSTROPHIC
|
Facility
|
OP
|
$166.60
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
30303054
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.59 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| 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 |
$70.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| 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 |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
TRIM NAIL(S) DYSTROPHIC
|
Facility
|
IP
|
$166.60
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
30303054
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$70.74
|
|
