|
ABBOTT 1PC MONO +14.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204759
|
|
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 +15.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204758
|
|
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 +15.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204853
|
|
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 +16.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204757
|
|
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 +16.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204756
|
|
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 +17.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204755
|
|
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 +17.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204754
|
|
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 +18.0 D
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40204753
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$156.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$208.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$176.80
|
| Rate for Payer: EmblemHealth Commercial |
$130.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.00
|
| Rate for Payer: Group Health Inc Commercial |
$130.00
|
| Rate for Payer: Group Health Inc Medicare |
$91.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.00
|
|
|
ABBOTT 1PC MONO +18.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204752
|
|
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 +19.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204751
|
|
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 +19.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204750
|
|
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 +20.0 D
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40204793
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$156.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$208.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$176.80
|
| Rate for Payer: EmblemHealth Commercial |
$130.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.00
|
| Rate for Payer: Group Health Inc Commercial |
$130.00
|
| Rate for Payer: Group Health Inc Medicare |
$91.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.00
|
|
|
ABBOTT 1PC MONO +20.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204794
|
|
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 +21.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204857
|
|
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 +21.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204858
|
|
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 +22.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204797
|
|
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 +22.5 D
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40204859
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$156.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$208.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$176.80
|
| Rate for Payer: EmblemHealth Commercial |
$130.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$273.00
|
| Rate for Payer: Group Health Inc Commercial |
$130.00
|
| Rate for Payer: Group Health Inc Medicare |
$91.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$169.00
|
|
|
ABBOTT 1PC MONO +23.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204852
|
|
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 +23.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204856
|
|
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 +24.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204851
|
|
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 +24.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204800
|
|
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 +25.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204799
|
|
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 +25.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204798
|
|
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 +26.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204796
|
|
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 +26.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204795
|
|
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
|
|
