|
ABBOTT 1PC MONO +27.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204854
|
|
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 +27.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204792
|
|
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 +28.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204791
|
|
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 +28.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204790
|
|
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 +29.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204789
|
|
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 +29.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204788
|
|
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 +30.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204787
|
|
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 +30.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204786
|
|
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 +31.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204785
|
|
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 +31.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204784
|
|
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 +32.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204783
|
|
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 +32.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204782
|
|
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 +33.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204781
|
|
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 +33.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204780
|
|
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 +34.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204779
|
|
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 +5.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204778
|
|
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 +5.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204777
|
|
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 +6.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204776
|
|
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 +6.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204775
|
|
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 +7.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204774
|
|
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 +7.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204773
|
|
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 +8.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204772
|
|
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 +8.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204771
|
|
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 +9.0 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204770
|
|
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 +9.5 D
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
HCPCS V2788
|
| Hospital Charge Code |
40204769
|
|
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
|
|
