|
ALCON/AMO LENS INTRAOCULAR
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40209080
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$233.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$255.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$340.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$289.00
|
| Rate for Payer: EmblemHealth Commercial |
$212.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$446.25
|
| Rate for Payer: Group Health Inc Commercial |
$212.50
|
| Rate for Payer: Group Health Inc Medicare |
$148.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$212.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$212.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$276.25
|
|
|
ALCON LENS GLIDE
|
Facility
|
OP
|
$320.40
|
|
| Hospital Charge Code |
40200483
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$112.14 |
| Max. Negotiated Rate |
$256.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$176.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$160.20
|
| Rate for Payer: Aetna Government |
$160.20
|
| Rate for Payer: Brighton Health Commercial |
$240.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$256.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$217.87
|
| Rate for Payer: Group Health Inc Commercial |
$160.20
|
| Rate for Payer: Group Health Inc Medicare |
$112.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$160.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.20
|
|
|
ALCON LENS INTRA 25.5 D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40209375
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALCON LENS INTRAOCULAR 11.0 D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40209368
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALCON LENS INTRAOCULAR18.5 D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40209370
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALCON LENS INTRAOCULAR 19.0 D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1840
|
| Hospital Charge Code |
40209374
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$648.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$648.95
|
| Rate for Payer: Aetna Government |
$648.95
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALCON LENS INTRAOCULAR 19.5 D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40209371
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALCON LENS INTRAOCULAR 20.0 D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1840
|
| Hospital Charge Code |
40209372
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$648.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$648.95
|
| Rate for Payer: Aetna Government |
$648.95
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALCON LENS INTRAOCULAR 20.5 D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40209381
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALCON LENS INTRAOCULAR 21.5 D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40209369
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALCON LENS INTRAOCULAR 22.0D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1840
|
| Hospital Charge Code |
40209376
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$648.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$648.95
|
| Rate for Payer: Aetna Government |
$648.95
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALCON LENS INTRAOCULAR 22.5D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40209377
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALCON LENS INTRAOCULAR 23.0D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40209378
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALCON LENS INTRAOCULAR 26.0D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40209379
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALCON LENS INTRAOCULAR 26.5D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40209380
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALCON LENS INTRAOCULAR 28.0 D
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1780
|
| Hospital Charge Code |
40209382
|
|
Hospital Revenue Code
|
276
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.26
|
| Rate for Payer: Aetna Government |
$2.26
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
ALC PHACO 20K LEGA
|
Facility
|
OP
|
$14,628.60
|
|
| Hospital Charge Code |
40004046
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$5,120.01 |
| Max. Negotiated Rate |
$11,702.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8,045.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,314.30
|
| Rate for Payer: Aetna Government |
$7,314.30
|
| Rate for Payer: Brighton Health Commercial |
$10,971.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,702.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,947.45
|
| Rate for Payer: Group Health Inc Commercial |
$7,314.30
|
| Rate for Payer: Group Health Inc Medicare |
$5,120.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,314.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,314.30
|
|
|
ALDOLASE
|
Facility
|
OP
|
$24.28
|
|
|
Service Code
|
HCPCS 82085
|
| Hospital Charge Code |
40609033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.71
|
| Rate for Payer: Aetna Government |
$9.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.80
|
| Rate for Payer: Brighton Health Commercial |
$18.21
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Cash Price |
$9.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.71
|
| Rate for Payer: EmblemHealth Commercial |
$9.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.64
|
| Rate for Payer: Group Health Inc Commercial |
$9.71
|
| Rate for Payer: Group Health Inc Medicare |
$9.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.71
|
| Rate for Payer: Healthfirst QHP |
$9.71
|
| Rate for Payer: Humana Medicare |
$9.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.71
|
| Rate for Payer: United Healthcare Commercial |
$12.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.77
|
| Rate for Payer: Wellcare Medicare |
$8.74
|
|
|
ALDOLASE
|
Facility
|
IP
|
$24.28
|
|
|
Service Code
|
HCPCS 82085
|
| Hospital Charge Code |
40609033
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$9.71
|
|
|
ALDOSTERONE LCMS, SERUM
|
Facility
|
OP
|
$101.36
|
|
|
Service Code
|
HCPCS 82088
|
| Hospital Charge Code |
40609034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.52 |
| Max. Negotiated Rate |
$76.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.75
|
| Rate for Payer: Aetna Government |
$40.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$28.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$28.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28.52
|
| Rate for Payer: Brighton Health Commercial |
$76.02
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Cash Price |
$40.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$40.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$54.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$40.75
|
| Rate for Payer: EmblemHealth Commercial |
$40.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$36.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$40.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$36.27
|
| Rate for Payer: Group Health Inc Commercial |
$40.75
|
| Rate for Payer: Group Health Inc Medicare |
$40.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.75
|
| Rate for Payer: Healthfirst QHP |
$40.75
|
| Rate for Payer: Humana Medicare |
$41.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40.75
|
| Rate for Payer: United Healthcare Commercial |
$51.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.60
|
| Rate for Payer: Wellcare Medicare |
$36.68
|
|
|
ALDOSTERONE LCMS, SERUM
|
Facility
|
IP
|
$101.36
|
|
|
Service Code
|
HCPCS 82088
|
| Hospital Charge Code |
40609034
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$40.75
|
|
|
ALENDRONATE 10 MG TAB
|
Facility
|
OP
|
$0.77
|
|
| Hospital Charge Code |
41653246
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Brighton Health Commercial |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.50
|
|
|
ALENDRONATE 10 MG TAB
|
Facility
|
OP
|
$0.77
|
|
| Hospital Charge Code |
41643246
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.39
|
| Rate for Payer: Aetna Government |
$0.39
|
| Rate for Payer: Brighton Health Commercial |
$0.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.52
|
| Rate for Payer: Group Health Inc Commercial |
$0.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.50
|
|
|
ALENDRONATE 35 MG TAB
|
Facility
|
OP
|
$1.89
|
|
| Hospital Charge Code |
41653435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.95
|
| Rate for Payer: Aetna Government |
$0.95
|
| Rate for Payer: Brighton Health Commercial |
$1.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.95
|
| Rate for Payer: Group Health Inc Medicare |
$0.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.23
|
|
|
ALENDRONATE 35 MG TAB
|
Facility
|
OP
|
$1.89
|
|
| Hospital Charge Code |
41643435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.95
|
| Rate for Payer: Aetna Government |
$0.95
|
| Rate for Payer: Brighton Health Commercial |
$1.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.95
|
| Rate for Payer: Group Health Inc Medicare |
$0.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.23
|
|
