|
FLUID AIR II BED
|
Facility
OP
|
$200.00
|
|
| Hospital Charge Code |
40209305
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.00
|
| Rate for Payer: Aetna Government |
$100.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
|
|
FLUIDAIR WITH SIT UP BED
|
Facility
OP
|
$200.00
|
|
| Hospital Charge Code |
40209302
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.00
|
| Rate for Payer: Aetna Government |
$100.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
|
|
FLU IMMUNIZE ORDER/ADMIN
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8482
|
| Hospital Charge Code |
30307867
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
FLULAVAL 5ML
|
Facility
OP
|
$16.72
|
|
|
Service Code
|
HCPCS Q2036
|
| Hospital Charge Code |
41645563
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$10.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.03
|
| Rate for Payer: Aetna Government |
$9.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.61
|
| Rate for Payer: Group Health Inc Commercial |
$8.36
|
| Rate for Payer: Group Health Inc Medicare |
$5.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.87
|
|
|
FLULAVAL 5ML
|
Facility
IP
|
$16.72
|
|
|
Service Code
|
HCPCS Q2036
|
| Hospital Charge Code |
41655563
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.36
|
|
|
FLULAVAL 5ML
|
Facility
OP
|
$16.72
|
|
|
Service Code
|
HCPCS Q2036
|
| Hospital Charge Code |
41655563
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$10.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.03
|
| Rate for Payer: Aetna Government |
$9.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.61
|
| Rate for Payer: Group Health Inc Commercial |
$8.36
|
| Rate for Payer: Group Health Inc Medicare |
$5.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.87
|
|
|
FLULAVAL 5ML
|
Facility
IP
|
$16.72
|
|
|
Service Code
|
HCPCS Q2036
|
| Hospital Charge Code |
41645563
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.36 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.36
|
|
|
FLULAVAL QUAD 0.5ML IM 3 YRS+
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41655971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$23.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.53
|
| Rate for Payer: Aetna Government |
$20.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.37
|
| Rate for Payer: Group Health Inc Commercial |
$16.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.69
|
| Rate for Payer: SOMOS Essential |
$23.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.80
|
|
|
FLULAVAL QUAD 0.5ML IM 3 YRS+
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41655971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
|
|
FLULAVAL QUAD 0.5ML IM 3YRS+
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41645971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$23.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.53
|
| Rate for Payer: Aetna Government |
$20.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.37
|
| Rate for Payer: Group Health Inc Commercial |
$16.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.52
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.69
|
| Rate for Payer: SOMOS Essential |
$23.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.80
|
|
|
FLULAVAL QUAD 0.5ML IM 3YRS+
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
HCPCS 90686
|
| Hospital Charge Code |
41645971
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.00
|
|
|
FLUMAZENIL 0.5 MG/5 ML INJ
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
41644424
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
FLUMAZENIL 0.5 MG/5 ML INJ
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
41654424
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
FLUMAZENIL 1 MG/10 ML INJ
|
Facility
OP
|
$19.13
|
|
| Hospital Charge Code |
41651574
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.56
|
| Rate for Payer: Aetna Government |
$9.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.01
|
| Rate for Payer: Group Health Inc Commercial |
$9.56
|
| Rate for Payer: Group Health Inc Medicare |
$6.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.43
|
|
|
FLUMAZENIL 1 MG/10 ML INJ
|
Facility
OP
|
$19.13
|
|
| Hospital Charge Code |
41641574
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.56
|
| Rate for Payer: Aetna Government |
$9.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.01
|
| Rate for Payer: Group Health Inc Commercial |
$9.56
|
| Rate for Payer: Group Health Inc Medicare |
$6.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.43
|
|
|
FLUMIST QUAD (VFC) 0.2ML INTRANAS
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 90672
|
| Hospital Charge Code |
41655959
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$29.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.88
|
| Rate for Payer: Aetna Government |
$26.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.19
|
| 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: Healthfirst CHP/FHP/Medicaid |
$26.88
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29.46
|
| Rate for Payer: SOMOS Essential |
$29.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
FLUMIST QUAD (VFC) 0.2ML INTRANAS
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS 90672
|
| Hospital Charge Code |
41655959
|
|
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
|
|
|
FLUMIST QUAD (VFC) 0.2ML NASAL
|
Facility
OP
|
$0.01
|
|
| Hospital Charge Code |
41645959
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| 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
|
|
|
FLUMIST QUAD (VFC) 0.2ML NASAL
|
Facility
IP
|
$0.01
|
|
| Hospital Charge Code |
41645959
|
|
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
|
|
|
FLUOCINONIDE TOPICAL 0.05% CREAM 15 GRAM
|
Facility
OP
|
$18.00
|
|
| Hospital Charge Code |
41650147
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.00
|
| Rate for Payer: Aetna Government |
$9.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.24
|
| Rate for Payer: Group Health Inc Commercial |
$9.00
|
| Rate for Payer: Group Health Inc Medicare |
$6.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.70
|
|
|
FLUOCINONIDE TOPICAL 0.05% CREAM 15 GRAM
|
Facility
OP
|
$18.00
|
|
| Hospital Charge Code |
41640147
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.00
|
| Rate for Payer: Aetna Government |
$9.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.24
|
| Rate for Payer: Group Health Inc Commercial |
$9.00
|
| Rate for Payer: Group Health Inc Medicare |
$6.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.70
|
|
|
FLUOCINONIDE TOPICAL 0.05% CREAM 30 GRAM
|
Facility
OP
|
$23.00
|
|
| Hospital Charge Code |
41650500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.50
|
| Rate for Payer: Aetna Government |
$11.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.64
|
| Rate for Payer: Group Health Inc Commercial |
$11.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.95
|
|
|
FLUOCINONIDE TOPICAL 0.05% CREAM 30 GRAM
|
Facility
OP
|
$23.00
|
|
| Hospital Charge Code |
41640500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.05 |
| Max. Negotiated Rate |
$18.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.50
|
| Rate for Payer: Aetna Government |
$11.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.64
|
| Rate for Payer: Group Health Inc Commercial |
$11.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.95
|
|
|
FLUOCINONIDE TOPICAL 0.05% CREAM 60 GRAM
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
41640729
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
FLUOCINONIDE TOPICAL 0.05% CREAM 60 GRAM
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
41650729
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
