|
ALLERGEN PROFILE, FOOD-FISH
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
ALLERGEN PROFILE, FOOD-MILK
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729869
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
ALLERGEN PROFILE, MOLD
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729321
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
ALLERGEN PROFILE, SHELLFISH
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729317
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
ALLERGENS(10)
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729873
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
ALLERGENS (2)
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729870
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
ALLERGENS(4)
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
ALLERGENS (5) GRASSES
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
ALLERGENS(9) MOLDS
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729320
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
ALLERGENS W/TOTAL IGE AREA 1
|
Facility
OP
|
$41.15
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
40609078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$26.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.46
|
| Rate for Payer: Aetna Government |
$16.46
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.46
|
| Rate for Payer: EmblemHealth Commercial |
$16.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.65
|
| Rate for Payer: Group Health Inc Commercial |
$16.46
|
| Rate for Payer: Group Health Inc Medicare |
$16.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.46
|
| Rate for Payer: Healthfirst QHP |
$16.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.17
|
| Rate for Payer: Wellcare Medicare |
$14.81
|
|
|
ALLERGIC REACTIONS WITH MCC
|
Facility
IP
|
$32,567.15
|
|
|
Service Code
|
MS-DRG 915
|
| Min. Negotiated Rate |
$14,846.79 |
| Max. Negotiated Rate |
$32,567.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,157.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31,928.58
|
| Rate for Payer: Aetna Government |
$31,928.58
|
| Rate for Payer: Brighton Health Commercial |
$25,723.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32,567.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30,635.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25,281.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$30,332.15
|
| Rate for Payer: EmblemHealth Commercial |
$15,212.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$31,928.58
|
| Rate for Payer: Group Health Inc Commercial |
$31,928.58
|
| Rate for Payer: Group Health Inc Medicare |
$31,928.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31,928.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,846.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31,928.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31,928.58
|
| Rate for Payer: Wellcare Medicare |
$30,332.15
|
|
|
ALLERGIC REACTIONS WITHOUT MCC
|
Facility
IP
|
$16,792.94
|
|
|
Service Code
|
MS-DRG 916
|
| Min. Negotiated Rate |
$5,649.21 |
| Max. Negotiated Rate |
$16,792.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,714.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,463.67
|
| Rate for Payer: Aetna Government |
$16,463.67
|
| Rate for Payer: Brighton Health Commercial |
$9,552.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16,792.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,376.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,388.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,640.49
|
| Rate for Payer: EmblemHealth Commercial |
$5,649.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,463.67
|
| Rate for Payer: Group Health Inc Commercial |
$16,463.67
|
| Rate for Payer: Group Health Inc Medicare |
$16,463.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,463.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,655.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,463.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,463.67
|
| Rate for Payer: Wellcare Medicare |
$15,640.49
|
|
|
ALLERGY EVALUATION
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40728050
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.70
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
ALLEVYN GENTLE BORDOR LITE 3 X 3
|
Facility
OP
|
$344.73
|
|
| Hospital Charge Code |
64905089
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$120.66 |
| Max. Negotiated Rate |
$275.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$189.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$172.36
|
| Rate for Payer: Aetna Government |
$172.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$275.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$234.42
|
| Rate for Payer: Group Health Inc Commercial |
$172.36
|
| Rate for Payer: Group Health Inc Medicare |
$120.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$172.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.36
|
|
|
ALLIS TISSUE FCPS 6
|
Facility
OP
|
$34.40
|
|
| Hospital Charge Code |
64905629
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$27.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.20
|
| Rate for Payer: Aetna Government |
$17.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.39
|
| Rate for Payer: Group Health Inc Commercial |
$17.20
|
| Rate for Payer: Group Health Inc Medicare |
$12.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.20
|
|
|
ALLODERM 8X16CM MED THICK
|
Facility
IP
|
$94.86
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
64905950
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.43 |
| Max. Negotiated Rate |
$47.43 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.43
|
|
|
ALLODERM 8X16CM MED THICK
|
Facility
OP
|
$94.86
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
64905950
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$61.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Government |
$21.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.54
|
| Rate for Payer: Group Health Inc Commercial |
$47.43
|
| Rate for Payer: Group Health Inc Medicare |
$33.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.66
|
|
|
ALLODERM 8X16CM THICK
|
Facility
OP
|
$94.86
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
64905937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$61.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Government |
$21.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.54
|
| Rate for Payer: Group Health Inc Commercial |
$47.43
|
| Rate for Payer: Group Health Inc Medicare |
$33.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.66
|
|
|
ALLODERM 8X16CM THICK
|
Facility
IP
|
$94.86
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
64905937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.43 |
| Max. Negotiated Rate |
$47.43 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.43
|
|
|
ALLODERM 8X16 SQCM
|
Facility
OP
|
$10,722.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
40204563
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$6,969.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,897.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Government |
$21.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,361.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,165.15
|
| Rate for Payer: Group Health Inc Commercial |
$5,361.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,752.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,361.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,361.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,969.30
|
|
|
ALLODERM 8X16 SQCM
|
Facility
IP
|
$10,722.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
40204563
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,361.00 |
| Max. Negotiated Rate |
$5,361.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,361.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,361.00
|
|
|
ALLODERM 8X20CM MED THICK
|
Facility
IP
|
$94.89
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
64905952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.44 |
| Max. Negotiated Rate |
$47.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.44
|
|
|
ALLODERM 8X20CM MED THICK
|
Facility
OP
|
$94.89
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
64905952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$61.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Government |
$21.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$47.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.56
|
| Rate for Payer: Group Health Inc Commercial |
$47.44
|
| Rate for Payer: Group Health Inc Medicare |
$33.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61.68
|
|
|
ALLODERM 9.6 SQCM CM1516
|
Facility
IP
|
$11,052.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
40204564
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,526.00 |
| Max. Negotiated Rate |
$5,526.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,526.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,526.00
|
|
|
ALLODERM 9.6 SQCM CM1516
|
Facility
OP
|
$11,052.00
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
40204564
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$7,183.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,078.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Government |
$21.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,526.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,354.90
|
| Rate for Payer: Group Health Inc Commercial |
$5,526.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,868.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,526.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,526.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,183.80
|
|
