|
F091-IGE MANGO
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729785
|
|
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
|
|
|
F093-IGE CHOCOLATE/CACAO
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729305
|
|
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
|
|
|
F094-IGE PEAR
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729786
|
|
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
|
|
|
F095-IGE PEACH
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729787
|
|
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
|
|
|
F201-IGE PECAN NUT
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729274
|
|
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
|
|
|
F202-IGE CASHEW NUT
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729271
|
|
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
|
|
|
F203-IGE PISTACHIO NUT
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729281
|
|
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
|
|
|
F207-IGE CLAM
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729293
|
|
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
|
|
|
F210-IGE PINEAPPLE
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729789
|
|
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
|
|
|
F211-IGE BLACKBERRY
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729790
|
|
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
|
|
|
F212-IGE MUSHROOM
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729791
|
|
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
|
|
|
F220-IGE CINNAMON
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729792
|
|
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
|
|
|
F224-IGE POPPY SEED
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729793
|
|
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
|
|
|
F242-IGE BING CHERRY
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729794
|
|
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
|
|
|
F256-IGE WALNUT
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729276
|
|
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
|
|
|
F259-IGE GRAPE
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729796
|
|
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
|
|
|
F270-IGE GINGER
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729797
|
|
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
|
|
|
F284-IGE TURKEY
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729798
|
|
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
|
|
|
F287-IGE KIDNEY BEAN
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729301
|
|
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
|
|
|
F288-IGE BLUEBERRY
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729312
|
|
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
|
|
|
F288-IGE_BLUEBERRY
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729799
|
|
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
|
|
|
F290-IGE OYSTER
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729292
|
|
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
|
|
|
F306-IGE LIME
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729800
|
|
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
|
|
|
F309-IGE CHICK PEA
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729801
|
|
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
|
|
|
F315-IGE GREEN BEAN
|
Facility
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729302
|
|
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
|
|
