|
CLARITHROMYCIN 125 MG/5 ML SUSP
|
Facility
|
OP
|
$0.76
|
|
| Hospital Charge Code |
41651428
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.38
|
| Rate for Payer: Aetna Government |
$0.38
|
| Rate for Payer: Brighton Health Commercial |
$0.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.49
|
|
|
CLARITHROMYCIN 250 MG/5 ML SUSP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41651430
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
CLARITHROMYCIN 250 MG/5 ML SUSP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41641430
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
CLARITHROMYCIN 250 MG PO TABS [9616]
|
Facility
|
OP
|
$6.02
|
|
|
Service Code
|
NDC 00527193106
|
| Hospital Charge Code |
00527193106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.01
|
| Rate for Payer: Aetna Government |
$3.01
|
| Rate for Payer: Brighton Health Commercial |
$4.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.09
|
| Rate for Payer: Group Health Inc Commercial |
$3.01
|
| Rate for Payer: Group Health Inc Medicare |
$2.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.91
|
|
|
CLARITHROMYCIN 250 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650824
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
CLARITHROMYCIN 250 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640824
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
CLARITHROMYCIN 500 MG PO TABS [9617]
|
Facility
|
OP
|
$6.02
|
|
|
Service Code
|
NDC 00527193206
|
| Hospital Charge Code |
00527193206
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.01
|
| Rate for Payer: Aetna Government |
$3.01
|
| Rate for Payer: Brighton Health Commercial |
$4.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.09
|
| Rate for Payer: Group Health Inc Commercial |
$3.01
|
| Rate for Payer: Group Health Inc Medicare |
$2.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.91
|
|
|
CLARITHROMYCIN 500 MG PO TABS [9617]
|
Facility
|
OP
|
$6.02
|
|
|
Service Code
|
NDC 00781196260
|
| Hospital Charge Code |
00781196260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.01
|
| Rate for Payer: Aetna Government |
$3.01
|
| Rate for Payer: Brighton Health Commercial |
$4.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.09
|
| Rate for Payer: Group Health Inc Commercial |
$3.01
|
| Rate for Payer: Group Health Inc Medicare |
$2.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.91
|
|
|
CLARITHROMYCIN 500 MG PO TABS [9617]
|
Facility
|
OP
|
$6.02
|
|
|
Service Code
|
NDC 65862022660
|
| Hospital Charge Code |
65862022660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.01
|
| Rate for Payer: Aetna Government |
$3.01
|
| Rate for Payer: Brighton Health Commercial |
$4.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.09
|
| Rate for Payer: Group Health Inc Commercial |
$3.01
|
| Rate for Payer: Group Health Inc Medicare |
$2.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.91
|
|
|
CLARITHROMYCIN 500 MG TAB
|
Facility
|
OP
|
$9.47
|
|
| Hospital Charge Code |
41654216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.74
|
| Rate for Payer: Aetna Government |
$4.74
|
| Rate for Payer: Brighton Health Commercial |
$7.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.74
|
| Rate for Payer: Group Health Inc Medicare |
$3.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.16
|
|
|
CLARITHROMYCIN 500 MG TAB
|
Facility
|
OP
|
$9.47
|
|
| Hospital Charge Code |
41644216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.74
|
| Rate for Payer: Aetna Government |
$4.74
|
| Rate for Payer: Brighton Health Commercial |
$7.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.74
|
| Rate for Payer: Group Health Inc Medicare |
$3.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.16
|
|
|
CLD TX CRP/MTCRP DS THMB MN WO AN
|
Facility
|
IP
|
$653.13
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
30306509
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$272.71
|
|
|
CLD TX CRP/MTCRP DS THMB MN WO AN
|
Facility
|
OP
|
$653.13
|
|
|
Service Code
|
HCPCS 26670
|
| Hospital Charge Code |
30306509
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$190.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.71
|
| Rate for Payer: Aetna Government |
$272.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$190.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$190.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$190.90
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.71
|
| 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 |
$272.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.71
|
| 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 |
$326.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$231.80
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| Rate for Payer: Humana Medicare |
$278.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.71
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$272.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$218.17
|
| Rate for Payer: Wellcare Medicare |
$259.07
|
|
|
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: 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
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
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: Brighton Health Commercial |
$0.10
|
| 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: Brighton Health Commercial |
$6.70
|
| 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: Brighton Health Commercial |
$11.48
|
| 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: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$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: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$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: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$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: Brighton Health Commercial |
$26.08
|
| 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: Brighton Health Commercial |
$12.08
|
| 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 |
$222.00 |
| 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: Affinity Essential Plan 1&2 |
$235.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$235.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$235.82
|
| 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: 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 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 Medicare Advantage |
$286.35
|
| Rate for Payer: Healthfirst QHP |
$336.88
|
| Rate for Payer: Humana Medicare |
$343.62
|
| 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: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare 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
|
|
|
CLEARANCE OF TEAR DUCT
|
Facility
|
IP
|
$819.25
|
|
|
Service Code
|
HCPCS 68530
|
| Hospital Charge Code |
30300156
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$336.88
|
|
|
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: Brighton Health Commercial |
$77.65
|
| 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
|
|
