|
FILTER WATER SEDIMENT REPLACEMENT
|
Facility
|
OP
|
$13.42
|
|
| Hospital Charge Code |
64902962
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.71
|
| Rate for Payer: Aetna Government |
$6.71
|
| Rate for Payer: Brighton Health Commercial |
$10.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.13
|
| Rate for Payer: Group Health Inc Commercial |
$6.71
|
| Rate for Payer: Group Health Inc Medicare |
$4.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.71
|
|
|
FINASTERIDE 5 MG PO TABS [10037]
|
Facility
|
OP
|
$3.13
|
|
|
Service Code
|
NDC 16729009016
|
| Hospital Charge Code |
16729009016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.56
|
| Rate for Payer: Aetna Government |
$1.56
|
| Rate for Payer: Brighton Health Commercial |
$2.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.13
|
| Rate for Payer: Group Health Inc Commercial |
$1.56
|
| Rate for Payer: Group Health Inc Medicare |
$1.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.03
|
|
|
FINASTERIDE 5 MG PO TABS [10037]
|
Facility
|
OP
|
$0.96
|
|
|
Service Code
|
NDC 60687042865
|
| Hospital Charge Code |
60687042865
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.48
|
| Rate for Payer: Aetna Government |
$0.48
|
| Rate for Payer: Brighton Health Commercial |
$0.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.65
|
| Rate for Payer: Group Health Inc Commercial |
$0.48
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.62
|
|
|
FINASTERIDE 5 MG PO TABS [10037]
|
Facility
|
OP
|
$3.11
|
|
|
Service Code
|
NDC 16729009010
|
| Hospital Charge Code |
16729009010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.56
|
| Rate for Payer: Aetna Government |
$1.56
|
| Rate for Payer: Brighton Health Commercial |
$2.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.12
|
| Rate for Payer: Group Health Inc Commercial |
$1.56
|
| Rate for Payer: Group Health Inc Medicare |
$1.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.02
|
|
|
FINASTERIDE 5 MG PO TABS [10037]
|
Facility
|
OP
|
$0.81
|
|
|
Service Code
|
NDC 00904683006
|
| Hospital Charge Code |
00904683006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.41
|
| Rate for Payer: Aetna Government |
$0.41
|
| Rate for Payer: Brighton Health Commercial |
$0.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.55
|
| Rate for Payer: Group Health Inc Commercial |
$0.41
|
| Rate for Payer: Group Health Inc Medicare |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.53
|
|
|
FINASTERIDE 5 MG PO TABS [10037]
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
NDC 00904683061
|
| Hospital Charge Code |
00904683061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.62
|
| Rate for Payer: Aetna Government |
$0.62
|
| Rate for Payer: Brighton Health Commercial |
$0.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.62
|
| Rate for Payer: Group Health Inc Medicare |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.80
|
|
|
FINASTERIDE 5 MG PO TABS [10037]
|
Facility
|
OP
|
$3.13
|
|
|
Service Code
|
NDC 16729009015
|
| Hospital Charge Code |
16729009015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.56
|
| Rate for Payer: Aetna Government |
$1.56
|
| Rate for Payer: Brighton Health Commercial |
$2.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.13
|
| Rate for Payer: Group Health Inc Commercial |
$1.56
|
| Rate for Payer: Group Health Inc Medicare |
$1.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.03
|
|
|
FINASTERIDE 5 MG TAB
|
Facility
|
OP
|
$1.74
|
|
|
Service Code
|
HCPCS S0138
|
| Hospital Charge Code |
41641260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$1.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.00
|
| Rate for Payer: Group Health Inc Commercial |
$0.87
|
| Rate for Payer: Group Health Inc Medicare |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.13
|
|
|
FINASTERIDE 5 MG TAB
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
HCPCS S0138
|
| Hospital Charge Code |
41641260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.87
|
|
|
FINASTERIDE 5 MG TAB
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
HCPCS S0138
|
| Hospital Charge Code |
41651260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.87
|
|
|
FINASTERIDE 5 MG TAB
|
Facility
|
OP
|
$1.74
|
|
|
Service Code
|
HCPCS S0138
|
| Hospital Charge Code |
41651260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$1.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.00
|
| Rate for Payer: Group Health Inc Commercial |
$0.87
|
| Rate for Payer: Group Health Inc Medicare |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.13
|
|
|
FINELINE II STEROX BIPOL PAS STER
|
Facility
|
OP
|
$1,687.50
|
|
| Hospital Charge Code |
64903842
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$590.62 |
| Max. Negotiated Rate |
$1,350.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$928.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$843.75
|
| Rate for Payer: Aetna Government |
$843.75
|
| Rate for Payer: Brighton Health Commercial |
$1,265.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,350.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,147.50
|
| Rate for Payer: Group Health Inc Commercial |
$843.75
|
| Rate for Payer: Group Health Inc Medicare |
$590.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$843.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$843.75
|
|
|
FINELINE II STEROX LEAD #4457
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
66573253
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$1,417.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$742.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.92
|
| Rate for Payer: Aetna Government |
$98.92
|
| Rate for Payer: Brighton Health Commercial |
$810.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$675.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$776.25
|
| Rate for Payer: EmblemHealth Commercial |
$675.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,417.50
|
| Rate for Payer: Group Health Inc Commercial |
$675.00
|
| Rate for Payer: Group Health Inc Medicare |
$472.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$675.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$675.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$877.50
|
|
|
Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion (List separately in addition to code for primary procedure)
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 10006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.17
|
| Rate for Payer: Aetna Government |
$42.17
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion (List separately in addition to code for primary procedure)
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 10006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.17
|
| Rate for Payer: Aetna Government |
$42.17
|
| 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: United Healthcare Commercial |
$1,113.00
|
|
|
Fine needle aspiration biopsy, including ultrasound guidance; first lesion
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 10005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$569.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$569.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$569.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$569.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| 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 |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$813.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Humana Medicare |
$829.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
Fine needle aspiration biopsy, including ultrasound guidance; first lesion
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 10005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$569.54 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$569.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$569.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$569.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| 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 |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$813.63
|
| Rate for Payer: Group Health Inc Medicare |
$813.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Humana Medicare |
$829.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
FINE NEEDLE ASP W/INTERP & REP
|
Facility
|
IP
|
$149.83
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
40635475
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$62.66
|
|
|
FINE NEEDLE ASP W/INTERP & REP
|
Facility
|
OP
|
$149.83
|
|
|
Service Code
|
HCPCS 88173
|
| Hospital Charge Code |
40635475
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$43.86 |
| Max. Negotiated Rate |
$82.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.66
|
| Rate for Payer: Aetna Government |
$62.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$43.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.86
|
| Rate for Payer: Brighton Health Commercial |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.66
|
| Rate for Payer: EmblemHealth Commercial |
$62.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.77
|
| Rate for Payer: Group Health Inc Commercial |
$62.66
|
| Rate for Payer: Group Health Inc Medicare |
$62.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$62.66
|
| Rate for Payer: Humana Medicare |
$63.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.13
|
| Rate for Payer: Wellcare Medicare |
$56.39
|
|
|
FINE NEEDLE ASP W/INTERP & REP
|
Facility
|
IP
|
$149.83
|
|
|
Service Code
|
HCPCS 88173 TC
|
| Hospital Charge Code |
40635476
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$62.66
|
|
|
FINE NEEDLE ASP W/INTERP & REP
|
Facility
|
OP
|
$149.83
|
|
|
Service Code
|
HCPCS 88173 TC
|
| Hospital Charge Code |
40635476
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$43.86 |
| Max. Negotiated Rate |
$82.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.66
|
| Rate for Payer: Aetna Government |
$62.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$43.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.86
|
| Rate for Payer: Brighton Health Commercial |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.66
|
| Rate for Payer: EmblemHealth Commercial |
$62.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.77
|
| Rate for Payer: Group Health Inc Commercial |
$62.66
|
| Rate for Payer: Group Health Inc Medicare |
$62.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$62.66
|
| Rate for Payer: Humana Medicare |
$63.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.13
|
| Rate for Payer: Wellcare Medicare |
$56.39
|
|
|
FINE NEEDLE ASP W/O IMAGE
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
30105940
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$461.12
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
FINE NEEDLE ASP W/O IMAGE
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
30305940
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
FINE NEEDLE ASP W/O IMAGE
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
30105940
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
FINE NEEDLE ASP W/O IMAGE
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 10021
|
| Hospital Charge Code |
30305940
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$461.12
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
