|
DIPHTHERIA + TETANUS TOXOID INJ SYR ADUL
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
41653864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.22
|
| Rate for Payer: Aetna Government |
$26.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.94
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.96
|
| Rate for Payer: SOMOS Essential |
$19.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
|
DIPHTHERIA + TETANUS TOXOID INJ SYR ADUL
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
41643864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
|
|
DIPHTHERIA + TETANUS TOXOIDS INJ ADULT
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
41644588
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.22
|
| Rate for Payer: Aetna Government |
$26.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.94
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.96
|
| Rate for Payer: SOMOS Essential |
$19.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
|
DIPHTHERIA + TETANUS TOXOIDS INJ ADULT
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
41654588
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
|
|
DIPHTHERIA + TETANUS TOXOIDS INJ ADULT
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
41654588
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$31.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.22
|
| Rate for Payer: Aetna Government |
$26.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27.94
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19.96
|
| Rate for Payer: SOMOS Essential |
$19.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
|
DIPHTHERIA + TETANUS TOXOIDS INJ ADULT
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 90714
|
| Hospital Charge Code |
41644588
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
|
|
DIPIVEFRIN 0.1% OPHTHALMIC SOLN
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41643410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
DIPIVEFRIN 0.1% OPHTHALMIC SOLN
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41653410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
DIPTHER/TETANUS/PERT/POLIO VACC
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
41657811
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
DIPTHER/TETANUS/PERT/POLIO VACC
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
41647811
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$56.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.24
|
| Rate for Payer: Aetna Government |
$56.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
DIPTHER/TETANUS/PERT/POLIO VACC
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
41647811
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
DIPTHER/TETANUS/PERT/POLIO VACC
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
41657811
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$56.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.24
|
| Rate for Payer: Aetna Government |
$56.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
DIPTHER/TETANUS/PERT/POLIO VFC
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
41657810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
DIPTHER/TETANUS/PERT/POLIO VFC
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
41647810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
DIPTHER/TETANUS/PERT/POLIO VFC
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
41657810
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$56.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.24
|
| Rate for Payer: Aetna Government |
$56.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
DIPTHER/TETANUS/PERT/POLIO VFC
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90696
|
| Hospital Charge Code |
41647810
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$56.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.24
|
| Rate for Payer: Aetna Government |
$56.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
DIPYRIDAMOLE 25 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41642963
|
|
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
|
|
|
DIPYRIDAMOLE 25 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41652963
|
|
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
|
|
|
DIPYRIDAMOLE 50 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41652964
|
|
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
|
|
|
DIPYRIDAMOLE 50 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41642964
|
|
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
|
|
|
DIPYRIDAMOLE 5 MG/ML INJ
|
Facility
IP
|
$1.65
|
|
|
Service Code
|
HCPCS J1245
|
| Hospital Charge Code |
41643733
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
|
|
DIPYRIDAMOLE 5 MG/ML INJ
|
Facility
IP
|
$1.65
|
|
|
Service Code
|
HCPCS J1245
|
| Hospital Charge Code |
41653733
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
|
|
DIPYRIDAMOLE 5 MG/ML INJ
|
Facility
OP
|
$1.65
|
|
|
Service Code
|
HCPCS J1245
|
| Hospital Charge Code |
41653733
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.65
|
| Rate for Payer: Aetna Government |
$3.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.96
|
| Rate for Payer: SOMOS Essential |
$3.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.07
|
|
|
DIPYRIDAMOLE 5 MG/ML INJ
|
Facility
OP
|
$1.65
|
|
|
Service Code
|
HCPCS J1245
|
| Hospital Charge Code |
41643733
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$3.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.65
|
| Rate for Payer: Aetna Government |
$3.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.96
|
| Rate for Payer: SOMOS Essential |
$3.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.07
|
|
|
DIPYRIDAMOLE 75 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41653521
|
|
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
|
|
