|
FLUOCINONIDE TOPICAL 0.05% OINT 15 GRAMS
|
Facility
OP
|
$28.00
|
|
| Hospital Charge Code |
41650096
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.00
|
| Rate for Payer: Aetna Government |
$14.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.04
|
| Rate for Payer: Group Health Inc Commercial |
$14.00
|
| Rate for Payer: Group Health Inc Medicare |
$9.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.20
|
|
|
FLUOCINONIDE TOPICAL 0.05% OINT 15 GRAMS
|
Facility
OP
|
$28.00
|
|
| Hospital Charge Code |
41640096
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.00
|
| Rate for Payer: Aetna Government |
$14.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.04
|
| Rate for Payer: Group Health Inc Commercial |
$14.00
|
| Rate for Payer: Group Health Inc Medicare |
$9.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.20
|
|
|
FLUOCINONIDE TOPICAL 0.05% OINT 30 GRAMS
|
Facility
OP
|
$16.00
|
|
| Hospital Charge Code |
41640183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.00
|
| Rate for Payer: Aetna Government |
$8.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.88
|
| Rate for Payer: Group Health Inc Commercial |
$8.00
|
| Rate for Payer: Group Health Inc Medicare |
$5.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.40
|
|
|
FLUOCINONIDE TOPICAL 0.05% OINT 30 GRAMS
|
Facility
OP
|
$16.00
|
|
| Hospital Charge Code |
41650183
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$12.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.00
|
| Rate for Payer: Aetna Government |
$8.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.88
|
| Rate for Payer: Group Health Inc Commercial |
$8.00
|
| Rate for Payer: Group Health Inc Medicare |
$5.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.40
|
|
|
FLUOCINONIDE TOPICAL 0.05% OINT 60 GRAMS
|
Facility
OP
|
$14.00
|
|
| Hospital Charge Code |
41640465
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.00
|
| Rate for Payer: Aetna Government |
$7.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.52
|
| Rate for Payer: Group Health Inc Commercial |
$7.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
|
|
FLUOCINONIDE TOPICAL 0.05% OINT 60 GRAMS
|
Facility
OP
|
$14.00
|
|
| Hospital Charge Code |
41650465
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.00
|
| Rate for Payer: Aetna Government |
$7.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.52
|
| Rate for Payer: Group Health Inc Commercial |
$7.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
|
|
FLUOCINONIDE TOPICAL 0.05% SOLN 60 ML
|
Facility
OP
|
$47.50
|
|
| Hospital Charge Code |
41643376
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.62 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.75
|
| Rate for Payer: Aetna Government |
$23.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.30
|
| Rate for Payer: Group Health Inc Commercial |
$23.75
|
| Rate for Payer: Group Health Inc Medicare |
$16.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.88
|
|
|
FLUOCINONIDE TOPICAL 0.05% SOLN 60 ML
|
Facility
OP
|
$47.50
|
|
| Hospital Charge Code |
41653376
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.62 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.75
|
| Rate for Payer: Aetna Government |
$23.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.30
|
| Rate for Payer: Group Health Inc Commercial |
$23.75
|
| Rate for Payer: Group Health Inc Medicare |
$16.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.88
|
|
|
FLUORESCEIN 10% INJ
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
41654214
|
|
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
|
|
|
FLUORESCEIN 10% INJ
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
41644214
|
|
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
|
|
|
FLUORESCEIN 1 MG OPHTHALMIC STRIP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41652276
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FLUORESCEIN 1 MG OPHTHALMIC STRIP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41642276
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FLUORESCEIN 25% INJ 2 ML
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41652730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
FLUORESCEIN 25% INJ 2 ML
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41642730
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
FLUORESCEIN ANGIOGRAPHY
|
Facility
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 92235 TC
|
| Hospital Charge Code |
30303078
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$105.68 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$383.29
|
| Rate for Payer: Aetna Government |
$383.29
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$613.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$521.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$105.68
|
| Rate for Payer: Group Health Inc Commercial |
$383.29
|
| Rate for Payer: Group Health Inc Medicare |
$268.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$383.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$117.42
|
|
|
FLUORESCEIN SODIUM
|
Facility
OP
|
$0.21
|
|
| Hospital Charge Code |
41648828
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
FLUORESCEIN SODIUM
|
Facility
OP
|
$0.21
|
|
| Hospital Charge Code |
41658828
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
FLUORESCENT ANTIBODY TITER
|
Facility
OP
|
$30.13
|
|
|
Service Code
|
HCPCS 86256
|
| Hospital Charge Code |
40609604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$19.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.64
|
| Rate for Payer: Wellcare Medicare |
$10.84
|
|
|
FLUORIDE GEL CARRIER
|
Facility
OP
|
$25.00
|
|
|
Service Code
|
HCPCS D5986
|
| Hospital Charge Code |
42301395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.67
|
| Rate for Payer: Aetna Government |
$36.67
|
| Rate for Payer: Amida Care Medicaid |
$97.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9,760.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$97.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$97.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$102.48
|
| Rate for Payer: Group Health Inc Commercial |
$12.50
|
| Rate for Payer: Group Health Inc Medicare |
$8.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$97.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.60
|
| Rate for Payer: Healthfirst Essential Plan |
$219.60
|
| Rate for Payer: Healthfirst QHP |
$97.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$97.60
|
| Rate for Payer: SOMOS Essential |
$219.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$97.60
|
|
|
FLUORODEOXYGLUCOSE F-18
|
Facility
OP
|
$275.00
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
41646582
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$260.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$151.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$260.79
|
| Rate for Payer: Aetna Government |
$260.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$220.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$187.00
|
| Rate for Payer: Group Health Inc Commercial |
$137.50
|
| Rate for Payer: Group Health Inc Medicare |
$96.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.50
|
|
|
FLUORODEOXYGLUCOSE F-18
|
Facility
OP
|
$275.00
|
|
|
Service Code
|
HCPCS A9552
|
| Hospital Charge Code |
41656582
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$260.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$151.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$260.79
|
| Rate for Payer: Aetna Government |
$260.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$220.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$187.00
|
| Rate for Payer: Group Health Inc Commercial |
$137.50
|
| Rate for Payer: Group Health Inc Medicare |
$96.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$137.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$137.50
|
|
|
FLUORO EXAM OF G/COLON TUI
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
30104004
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
FLUORO EXAM OF G/COLON TUI
|
Facility
OP
|
$705.83
|
|
|
Service Code
|
HCPCS 49465
|
| Hospital Charge Code |
30304004
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.37
|
| Rate for Payer: Aetna Government |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Cash Price |
$283.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.37
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.20
|
| Rate for Payer: Group Health Inc Commercial |
$283.37
|
| Rate for Payer: Group Health Inc Medicare |
$283.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.86
|
| Rate for Payer: Healthfirst QHP |
$283.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$226.70
|
| Rate for Payer: Wellcare Medicare |
$269.20
|
|
|
FLUOROGUIDE FOR SPINE INJECTION
|
Facility
OP
|
$263.18
|
|
|
Service Code
|
HCPCS 77003 TC
|
| Hospital Charge Code |
41109862
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.46 |
| Max. Negotiated Rate |
$210.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$144.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$131.59
|
| Rate for Payer: Aetna Government |
$131.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$210.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$178.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$86.46
|
| Rate for Payer: Group Health Inc Commercial |
$131.59
|
| Rate for Payer: Group Health Inc Medicare |
$92.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$131.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$131.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.07
|
|
|
FLUOROMETHOLONE 0.1% OPHTHALMIC SUSP
|
Facility
OP
|
$16.68
|
|
| Hospital Charge Code |
41644083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$13.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.34
|
| Rate for Payer: Aetna Government |
$8.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.34
|
| Rate for Payer: Group Health Inc Commercial |
$8.34
|
| Rate for Payer: Group Health Inc Medicare |
$5.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.84
|
|
