|
ABACAVIR 300 MG TAB
|
Facility
|
OP
|
$18.43
|
|
| Hospital Charge Code |
41642020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.22
|
| Rate for Payer: Aetna Government |
$9.22
|
| Rate for Payer: Brighton Health Commercial |
$13.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.53
|
| Rate for Payer: Group Health Inc Commercial |
$9.22
|
| Rate for Payer: Group Health Inc Medicare |
$6.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.98
|
|
|
ABACAVIR-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS [126772]
|
Facility
|
OP
|
$149.90
|
|
|
Service Code
|
NDC 49702023113
|
| Hospital Charge Code |
49702023113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.47 |
| Max. Negotiated Rate |
$119.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.95
|
| Rate for Payer: Aetna Government |
$74.95
|
| Rate for Payer: Brighton Health Commercial |
$112.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$119.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$101.93
|
| Rate for Payer: Group Health Inc Commercial |
$74.95
|
| Rate for Payer: Group Health Inc Medicare |
$52.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$97.44
|
|
|
ABACAVIR-LAMIVUDINE-ZIDOVUDINE 300-150-300 MG PO TABS [29167]
|
Facility
|
OP
|
$32.19
|
|
|
Service Code
|
NDC 49702021718
|
| Hospital Charge Code |
49702021718
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Government |
$16.10
|
| Rate for Payer: Brighton Health Commercial |
$24.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.89
|
| Rate for Payer: Group Health Inc Commercial |
$16.10
|
| Rate for Payer: Group Health Inc Medicare |
$11.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.93
|
|
|
ABACAVIR SULFATE 20 MG/ML PO SOLN [24439]
|
Facility
|
OP
|
$0.65
|
|
|
Service Code
|
NDC 31722056224
|
| Hospital Charge Code |
31722056224
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Brighton Health Commercial |
$0.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.44
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.43
|
|
|
ABACAVIR SULFATE 20 MG/ML PO SOLN [24439]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
NDC 49702022248
|
| Hospital Charge Code |
49702022248
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Brighton Health Commercial |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.50
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.48
|
|
|
ABACAVIR SULFATE 20 MG/ML PO SOLN [24439]
|
Facility
|
OP
|
$0.65
|
|
|
Service Code
|
NDC 64980040524
|
| Hospital Charge Code |
64980040524
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Brighton Health Commercial |
$0.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.44
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.43
|
|
|
ABACAVIR SULFATE 300 MG PO TABS [24438]
|
Facility
|
OP
|
$10.04
|
|
|
Service Code
|
NDC 68084002111
|
| Hospital Charge Code |
68084002111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$8.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Brighton Health Commercial |
$7.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.83
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$3.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.53
|
|
|
ABACAVIR SULFATE 300 MG PO TABS [24438]
|
Facility
|
OP
|
$10.04
|
|
|
Service Code
|
NDC 50268004912
|
| Hospital Charge Code |
50268004912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$8.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Brighton Health Commercial |
$7.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.83
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$3.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.53
|
|
|
ABACAVIR SULFATE 300 MG PO TABS [24438]
|
Facility
|
OP
|
$10.04
|
|
|
Service Code
|
NDC 00378410591
|
| Hospital Charge Code |
00378410591
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$8.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Brighton Health Commercial |
$7.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.83
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$3.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.53
|
|
|
ABACAVIR SULFATE 300 MG PO TABS [24438]
|
Facility
|
OP
|
$10.04
|
|
|
Service Code
|
NDC 68084002121
|
| Hospital Charge Code |
68084002121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$8.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Brighton Health Commercial |
$7.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.83
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$3.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.53
|
|
|
ABACAVIR SULFATE 300 MG PO TABS [24438]
|
Facility
|
OP
|
$10.05
|
|
|
Service Code
|
NDC 31722055760
|
| Hospital Charge Code |
31722055760
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$8.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Brighton Health Commercial |
$7.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.83
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$3.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.53
|
|
|
ABACAVIR SULFATE 300 MG PO TABS [24438]
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
NDC 00904687404
|
| Hospital Charge Code |
00904687404
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$8.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.20
|
| Rate for Payer: Aetna Government |
$5.20
|
| Rate for Payer: Brighton Health Commercial |
$7.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.07
|
| Rate for Payer: Group Health Inc Commercial |
$5.20
|
| Rate for Payer: Group Health Inc Medicare |
$3.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.76
|
|
|
ABACAVIR SULFATE-LAMIVUDINE 600-300 MG PO TABS [39301]
|
Facility
|
OP
|
$46.50
|
|
|
Service Code
|
NDC 69097036202
|
| Hospital Charge Code |
69097036202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$37.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Government |
$23.25
|
| Rate for Payer: Brighton Health Commercial |
$34.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.62
|
| Rate for Payer: Group Health Inc Commercial |
$23.25
|
| Rate for Payer: Group Health Inc Medicare |
$16.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.23
|
|
|
ABACAVIR SULFATE-LAMIVUDINE 600-300 MG PO TABS [39301]
|
Facility
|
OP
|
$46.50
|
|
|
Service Code
|
NDC 68180028806
|
| Hospital Charge Code |
68180028806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$37.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Government |
$23.25
|
| Rate for Payer: Brighton Health Commercial |
$34.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.62
|
| Rate for Payer: Group Health Inc Commercial |
$23.25
|
| Rate for Payer: Group Health Inc Medicare |
$16.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.23
|
|
|
ABATACEPT 250 MG IV SOLR [70287]
|
Facility
|
OP
|
$1,713.84
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
00003218713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.53 |
| Max. Negotiated Rate |
$3,617.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$942.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.16
|
| Rate for Payer: Aetna Government |
$43.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$81.38
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$81.38
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$36.17
|
| Rate for Payer: Amida Care Medicaid |
$36.17
|
| Rate for Payer: Brighton Health Commercial |
$1,028.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$856.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$985.46
|
| Rate for Payer: Elderplan Medicare Advantage |
$43.16
|
| Rate for Payer: EmblemHealth Commercial |
$856.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,617.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.98
|
| Rate for Payer: Group Health Inc Commercial |
$43.16
|
| Rate for Payer: Group Health Inc Medicare |
$43.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$856.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.17
|
| Rate for Payer: Healthfirst Essential Plan |
$81.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.69
|
| Rate for Payer: Healthfirst QHP |
$36.17
|
| Rate for Payer: Humana Medicare |
$44.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.16
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.17
|
| Rate for Payer: SOMOS Essential |
$36.17
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$81.38
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$39.79
|
| Rate for Payer: United Healthcare Medicaid |
$36.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,114.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.53
|
|
|
ABATACEPT 250 MG IV SOLR [70287]
|
Facility
|
IP
|
$1,713.84
|
|
|
Service Code
|
HCPCS J0129
|
| Hospital Charge Code |
00003218713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$856.92 |
| Max. Negotiated Rate |
$856.92 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$856.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$856.92
|
|
|
ABBOTT 1PC MONO +10.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204768
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.06
|
| Rate for Payer: Aetna Government |
$85.06
|
| Rate for Payer: Brighton Health Commercial |
$360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: EmblemHealth Commercial |
$300.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.00
|
|
|
ABBOTT 1PC MONO +10.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204767
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.06
|
| Rate for Payer: Aetna Government |
$85.06
|
| Rate for Payer: Brighton Health Commercial |
$360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: EmblemHealth Commercial |
$300.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.00
|
|
|
ABBOTT 1PC MONO +11.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204766
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.06
|
| Rate for Payer: Aetna Government |
$85.06
|
| Rate for Payer: Brighton Health Commercial |
$360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: EmblemHealth Commercial |
$300.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.00
|
|
|
ABBOTT 1PC MONO +11.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204765
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.06
|
| Rate for Payer: Aetna Government |
$85.06
|
| Rate for Payer: Brighton Health Commercial |
$360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: EmblemHealth Commercial |
$300.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.00
|
|
|
ABBOTT 1PC MONO +12.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204764
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.06
|
| Rate for Payer: Aetna Government |
$85.06
|
| Rate for Payer: Brighton Health Commercial |
$360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: EmblemHealth Commercial |
$300.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.00
|
|
|
ABBOTT 1PC MONO +12.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204763
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.06
|
| Rate for Payer: Aetna Government |
$85.06
|
| Rate for Payer: Brighton Health Commercial |
$360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: EmblemHealth Commercial |
$300.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.00
|
|
|
ABBOTT 1PC MONO +13.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204762
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.06
|
| Rate for Payer: Aetna Government |
$85.06
|
| Rate for Payer: Brighton Health Commercial |
$360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: EmblemHealth Commercial |
$300.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.00
|
|
|
ABBOTT 1PC MONO +13.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204761
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.06
|
| Rate for Payer: Aetna Government |
$85.06
|
| Rate for Payer: Brighton Health Commercial |
$360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: EmblemHealth Commercial |
$300.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.00
|
|
|
ABBOTT 1PC MONO +14.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204760
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.06
|
| Rate for Payer: Aetna Government |
$85.06
|
| Rate for Payer: Brighton Health Commercial |
$360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: EmblemHealth Commercial |
$300.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$630.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$390.00
|
|
