|
CLD TX OF FEM PROX END HEAD W/MAN
|
Facility
OP
|
$1,395.87
|
|
|
Service Code
|
HCPCS 27268
|
| Hospital Charge Code |
30107907
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$546.88
|
| Rate for Payer: Aetna Government |
$546.88
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| 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: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$623.75
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$697.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$697.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
|
|
CLEANER NAIL/PICKS STERILLUM
|
Facility
OP
|
$0.13
|
|
| Hospital Charge Code |
64904756
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
|
|
CLEANER QUAT ALCO DISINFECT
|
Facility
OP
|
$8.93
|
|
| Hospital Charge Code |
64901807
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.46
|
| Rate for Payer: Aetna Government |
$4.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.07
|
| Rate for Payer: Group Health Inc Commercial |
$4.46
|
| Rate for Payer: Group Health Inc Medicare |
$3.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.46
|
|
|
CLEANER RENUZYME FOAM SPRAY
|
Facility
OP
|
$15.30
|
|
| Hospital Charge Code |
64903347
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.65
|
| Rate for Payer: Aetna Government |
$7.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.40
|
| Rate for Payer: Group Health Inc Commercial |
$7.65
|
| Rate for Payer: Group Health Inc Medicare |
$5.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.65
|
|
|
CLEAN & INSPECT REM DENT MAN
|
Facility
OP
|
$250.00
|
|
|
Service Code
|
HCPCS D9933
|
| Hospital Charge Code |
42303476
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.05
|
| Rate for Payer: Aetna Government |
$27.05
|
| 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 |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
|
CLEAN & INSPECT REM DENT MAX
|
Facility
OP
|
$250.00
|
|
|
Service Code
|
HCPCS D9932
|
| Hospital Charge Code |
42303475
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.27
|
| Rate for Payer: Aetna Government |
$20.27
|
| 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 |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
|
CLEAN REM PART DENTURE MAND
|
Facility
OP
|
$250.00
|
|
|
Service Code
|
HCPCS D9935
|
| Hospital Charge Code |
42303478
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13.03 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.03
|
| Rate for Payer: Aetna Government |
$13.03
|
| 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 |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
|
CLEAN REM PART DENTURE MAX
|
Facility
OP
|
$34.77
|
|
|
Service Code
|
HCPCS D9934
|
| Hospital Charge Code |
42303477
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.67
|
| Rate for Payer: Aetna Government |
$52.67
|
| 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 |
$17.38
|
| Rate for Payer: Group Health Inc Medicare |
$12.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.38
|
|
|
CLEANSER,WOUND,SKINTEGRITY
|
Facility
OP
|
$16.10
|
|
| Hospital Charge Code |
64903404
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Government |
$8.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.95
|
| Rate for Payer: Group Health Inc Commercial |
$8.05
|
| Rate for Payer: Group Health Inc Medicare |
$5.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.05
|
|
|
CLEARANCE OF TEAR DUCT
|
Facility
OP
|
$819.25
|
|
|
Service Code
|
HCPCS 68530
|
| Hospital Charge Code |
30300156
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$336.88
|
| Rate for Payer: Aetna Government |
$336.88
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.88
|
| 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 |
$336.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$267.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.82
|
| 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 |
$409.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$286.35
|
| Rate for Payer: Healthfirst QHP |
$336.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.50
|
| Rate for Payer: Wellcare Medicare |
$320.04
|
|
|
CLEARIFY
|
Facility
OP
|
$103.53
|
|
| Hospital Charge Code |
64907094
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$82.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.76
|
| Rate for Payer: Aetna Government |
$51.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$70.40
|
| Rate for Payer: Group Health Inc Commercial |
$51.76
|
| Rate for Payer: Group Health Inc Medicare |
$36.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.76
|
|
|
CLEAR OUTER EA CANAL W/ANEST
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
30305958
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.71 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
OP
|
$296.00
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
30300107
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$148.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
CLEAR OUTER EAR CANAL
|
Facility
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 69200
|
| Hospital Charge Code |
30301070
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$52.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
CLEAR OUTER EAR CANAL W/ANESTHESI
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 69205
|
| Hospital Charge Code |
40109205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$106.71 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$118.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
CLEARVIEW MANDIBLE MADEL
|
Facility
OP
|
$6,246.80
|
|
| Hospital Charge Code |
64905050
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,186.38 |
| Max. Negotiated Rate |
$4,997.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,435.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,123.40
|
| Rate for Payer: Aetna Government |
$3,123.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,997.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,247.82
|
| Rate for Payer: Group Health Inc Commercial |
$3,123.40
|
| Rate for Payer: Group Health Inc Medicare |
$2,186.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,123.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,123.40
|
|
|
CLEARVIEW, VSP MODEL
|
Facility
OP
|
$8,126.38
|
|
| Hospital Charge Code |
64906165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,844.23 |
| Max. Negotiated Rate |
$6,501.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,469.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,063.19
|
| Rate for Payer: Aetna Government |
$4,063.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,501.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,525.94
|
| Rate for Payer: Group Health Inc Commercial |
$4,063.19
|
| Rate for Payer: Group Health Inc Medicare |
$2,844.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,063.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,063.19
|
|
|
CLEFT LIP REPAIR BILATERAL
|
Facility
OP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 40701
|
| Hospital Charge Code |
40019508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,337.07 |
| Max. Negotiated Rate |
$7,345.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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 |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,337.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,485.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
CLEFT LIP REPAIR UNILATERAL
|
Facility
OP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 40700
|
| Hospital Charge Code |
40019507
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,131.84 |
| Max. Negotiated Rate |
$7,345.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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 |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,131.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,257.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
CLEFT PALATE REPAIR
|
Facility
OP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 42200
|
| Hospital Charge Code |
40019506
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,043.42 |
| Max. Negotiated Rate |
$7,345.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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 |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,043.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,159.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
CLENSICARE BED
|
Facility
OP
|
$229.99
|
|
| Hospital Charge Code |
40209140
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$183.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$115.00
|
| Rate for Payer: Aetna Government |
$115.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$183.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.39
|
| Rate for Payer: Group Health Inc Commercial |
$115.00
|
| Rate for Payer: Group Health Inc Medicare |
$80.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$115.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$115.00
|
|
|
CLINDAMYCIN 12 MG/ML INJ PEDIATRIC
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CLINDAMYCIN 12 MG/ML INJ PEDIATRIC
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
CLINDAMYCIN 150 MG CAP
|
Facility
OP
|
$0.04
|
|
| Hospital Charge Code |
41642758
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
CLINDAMYCIN 150 MG CAP
|
Facility
OP
|
$0.04
|
|
| Hospital Charge Code |
41652758
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
