|
DESMOPRESSIN 0.1 MG TAB
|
Facility
OP
|
$1.93
|
|
| Hospital Charge Code |
41644625
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.97
|
| Rate for Payer: Aetna Government |
$0.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.97
|
| Rate for Payer: Group Health Inc Medicare |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.25
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 10 ML
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41641285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.64
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.65
|
| Rate for Payer: SOMOS Essential |
$6.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 10 ML
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41651285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 10 ML
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41651285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.64
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.65
|
| Rate for Payer: SOMOS Essential |
$6.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 10 ML
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41641285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 1 ML
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41653941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 1 ML
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41643941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 1 ML
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41643941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.64
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.65
|
| Rate for Payer: SOMOS Essential |
$6.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 1 ML
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41653941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.64
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.65
|
| Rate for Payer: SOMOS Essential |
$6.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN NASAL SPRAY 0.01%
|
Facility
OP
|
$378.18
|
|
| Hospital Charge Code |
41653938
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$132.36 |
| Max. Negotiated Rate |
$302.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$208.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$189.09
|
| Rate for Payer: Aetna Government |
$189.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$302.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$257.16
|
| Rate for Payer: Group Health Inc Commercial |
$189.09
|
| Rate for Payer: Group Health Inc Medicare |
$132.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.82
|
|
|
DESMOPRESSIN NASAL SPRAY 0.01%
|
Facility
OP
|
$378.18
|
|
| Hospital Charge Code |
41643938
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$132.36 |
| Max. Negotiated Rate |
$302.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$208.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$189.09
|
| Rate for Payer: Aetna Government |
$189.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$302.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$257.16
|
| Rate for Payer: Group Health Inc Commercial |
$189.09
|
| Rate for Payer: Group Health Inc Medicare |
$132.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.82
|
|
|
DEST BY NEUR AGENT CER/THOR EA AD
|
Facility
OP
|
$457.25
|
|
|
Service Code
|
HCPCS 64634
|
| Hospital Charge Code |
30305738
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78.07
|
| Rate for Payer: Aetna Government |
$78.07
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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: Fidelis CHP/HARP/Medicaid |
$70.55
|
| 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 |
$228.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.39
|
|
|
DEST BY NEUR AGENT LUMB/SAC SINGL
|
Facility
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
30305739
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$203.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| 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 |
$2,232.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| 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 |
$2,603.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$226.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,232.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
DEST BY NEUR AGENT W/IMAGING
|
Facility
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
30305737
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$203.07 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| 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 |
$2,232.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$203.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| 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 |
$2,603.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$225.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,232.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
DEST LESION, PENIS,SIMPLE,CRYO
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 54056
|
| Hospital Charge Code |
42201709
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.26 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$134.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
DEST OF LESION(S) BY PHYS OR CHEM
|
Facility
OP
|
$425.00
|
|
|
Service Code
|
HCPCS D7465
|
| Hospital Charge Code |
42301810
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.37 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$233.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$119.37
|
| Rate for Payer: Aetna Government |
$119.37
|
| 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 |
$212.50
|
| Rate for Payer: Group Health Inc Medicare |
$148.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.50
|
|
|
DESTR CUT VASC LES, 10 SQ CM/<
|
Facility
OP
|
$919.20
|
|
|
Service Code
|
HCPCS 17106
|
| Hospital Charge Code |
42201702
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$299.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$459.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$333.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
DESTR CV LES, 10 - 50 SQCM
|
Facility
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 17107
|
| Hospital Charge Code |
42201703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$388.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| 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 |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$432.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
DESTR LESION(S), PENIS, SIMPLE, C
|
Facility
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 54050
|
| Hospital Charge Code |
42201708
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.46 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$117.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
DESTR LESION(S), PENIS, SIMPLE, L
|
Facility
OP
|
$4,914.88
|
|
|
Service Code
|
HCPCS 54057
|
| Hospital Charge Code |
42201710
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$107.48 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,108.87
|
| Rate for Payer: Aetna Government |
$2,108.87
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Cash Price |
$2,108.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,108.87
|
| 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 |
$2,108.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,792.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,876.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,108.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,876.89
|
| 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 |
$2,457.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,108.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$119.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,792.54
|
| Rate for Payer: Healthfirst QHP |
$2,108.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,108.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,108.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,108.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,687.10
|
| Rate for Payer: Wellcare Medicare |
$2,003.43
|
|
|
DESTR MLES F/E/E/N/L/MM, 0.5/<
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
42201721
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.84 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
DESTR MLES F/E/E/N/L/MM, 0.6-1CM
|
Facility
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 17281
|
| Hospital Charge Code |
42201722
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.66 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$127.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
DESTR MLES F/E/E/N/L/MM, 1.1-2CM
|
Facility
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 17282
|
| Hospital Charge Code |
42201723
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$147.10 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
DESTR MLES F/E/E/N/L/MM, 2.1-3CM
|
Facility
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 17283
|
| Hospital Charge Code |
42201724
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$182.52 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$182.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$202.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
DESTR M LES S/N/H/F/G, 0.5 CM/<
|
Facility
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 17270
|
| Hospital Charge Code |
42201734
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$104.14 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
