|
FLUOCINONIDE 0.05 % EX SOLN [3190]
|
Facility
|
OP
|
$1.93
|
|
|
Service Code
|
NDC 70710128403
|
| Hospital Charge Code |
70710128403
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.97
|
| Rate for Payer: Aetna Government |
$0.97
|
| Rate for Payer: Brighton Health Commercial |
$1.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.31
|
| Rate for Payer: Group Health Inc Commercial |
$0.97
|
| Rate for Payer: Group Health Inc Medicare |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.26
|
|
|
FLUOCINONIDE 0.05 % EX SOLN [3190]
|
Facility
|
OP
|
$0.80
|
|
|
Service Code
|
NDC 00168013460
|
| Hospital Charge Code |
00168013460
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.40
|
| Rate for Payer: Aetna Government |
$0.40
|
| Rate for Payer: Brighton Health Commercial |
$0.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.54
|
| Rate for Payer: Group Health Inc Commercial |
$0.40
|
| Rate for Payer: Group Health Inc Medicare |
$0.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.52
|
|
|
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: Brighton Health Commercial |
$13.50
|
| 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: Brighton Health Commercial |
$13.50
|
| 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: Brighton Health Commercial |
$17.25
|
| 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: Brighton Health Commercial |
$17.25
|
| 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 |
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: Brighton Health Commercial |
$6.00
|
| 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 |
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: Brighton Health Commercial |
$6.00
|
| 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% 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: Brighton Health Commercial |
$21.00
|
| 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 |
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: Brighton Health Commercial |
$21.00
|
| 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: Brighton Health Commercial |
$12.00
|
| 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: Brighton Health Commercial |
$12.00
|
| 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 |
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: Brighton Health Commercial |
$10.50
|
| 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 |
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: Brighton Health Commercial |
$10.50
|
| 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 |
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: Brighton Health Commercial |
$35.62
|
| 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 |
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: Brighton Health Commercial |
$35.62
|
| 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 |
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: Brighton Health Commercial |
$6.00
|
| 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 |
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: Brighton Health Commercial |
$6.00
|
| 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: Brighton Health Commercial |
$0.75
|
| 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: Brighton Health Commercial |
$0.75
|
| 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 |
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: Brighton Health Commercial |
$4.50
|
| 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 |
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: Brighton Health Commercial |
$4.50
|
| 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
|
IP
|
$766.58
|
|
|
Service Code
|
HCPCS 92235 TC
|
| Hospital Charge Code |
30303078
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$362.98
|
|
|
FLUORESCEIN ANGIOGRAPHY
|
Facility
|
OP
|
$766.58
|
|
|
Service Code
|
HCPCS 92235 TC
|
| Hospital Charge Code |
30303078
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$613.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$362.98
|
| Rate for Payer: Aetna Government |
$362.98
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$254.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$254.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$254.09
|
| Rate for Payer: Brighton Health Commercial |
$574.94
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Cash Price |
$362.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$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: Elderplan Medicare Advantage |
$362.98
|
| Rate for Payer: EmblemHealth Commercial |
$362.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$308.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$323.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$362.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$362.98
|
| Rate for Payer: Group Health Inc Medicare |
$362.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$362.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$308.53
|
| Rate for Payer: Healthfirst QHP |
$362.98
|
| Rate for Payer: Humana Medicare |
$370.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$362.98
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$362.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$362.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$290.38
|
| Rate for Payer: Wellcare Medicare |
$344.83
|
|
|
FLUORESCEIN-BENOXINATE 0.25-0.4 % OP SOLN [10061]
|
Facility
|
OP
|
$7.68
|
|
|
Service Code
|
NDC 59390021805
|
| Hospital Charge Code |
59390021805
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$6.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.84
|
| Rate for Payer: Aetna Government |
$3.84
|
| Rate for Payer: Brighton Health Commercial |
$5.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.22
|
| Rate for Payer: Group Health Inc Commercial |
$3.84
|
| Rate for Payer: Group Health Inc Medicare |
$2.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.99
|
|
