|
GRFT STRAIGHT HEMASHIELD
|
Facility
|
OP
|
$850.00
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
40209675
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.50 |
| Max. Negotiated Rate |
$1,879.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$467.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,879.82
|
| Rate for Payer: Aetna Government |
$1,879.82
|
| Rate for Payer: Brighton Health Commercial |
$510.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$425.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$488.75
|
| Rate for Payer: EmblemHealth Commercial |
$425.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$892.50
|
| Rate for Payer: Group Health Inc Commercial |
$425.00
|
| Rate for Payer: Group Health Inc Medicare |
$297.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$425.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$425.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$552.50
|
|
|
GRIP CABLE 1.8MM 36'
|
Facility
|
OP
|
$1,130.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,187.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$622.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$678.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$565.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$650.30
|
| Rate for Payer: EmblemHealth Commercial |
$565.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,187.50
|
| Rate for Payer: Group Health Inc Commercial |
$565.48
|
| Rate for Payer: Group Health Inc Medicare |
$395.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$565.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$565.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$735.12
|
|
|
GRIP CABLE 1.8MM 36'
|
Facility
|
IP
|
$1,130.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906987
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.48 |
| Max. Negotiated Rate |
$565.48 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$565.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$565.48
|
|
|
GRISEOFULVIN 125 MG/5 ML SUSP
|
Facility
|
OP
|
$0.29
|
|
| Hospital Charge Code |
41651765
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.19
|
|
|
GRISEOFULVIN 125 MG/5 ML SUSP
|
Facility
|
OP
|
$0.29
|
|
| Hospital Charge Code |
41641765
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.19
|
|
|
GRISEOFULVIN MICROSIZE 125 MG/5ML PO SUSP [10138]
|
Facility
|
OP
|
$0.65
|
|
|
Service Code
|
NDC 69097036108
|
| Hospital Charge Code |
69097036108
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.33
|
| Rate for Payer: Aetna Government |
$0.33
|
| Rate for Payer: Brighton Health Commercial |
$0.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.44
|
| Rate for Payer: Group Health Inc Commercial |
$0.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.42
|
|
|
GRISEOFULVIN ULTRAMICROCRYSTALLINE 250 M
|
Facility
|
OP
|
$5.03
|
|
| Hospital Charge Code |
41653120
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.52
|
| Rate for Payer: Aetna Government |
$2.52
|
| Rate for Payer: Brighton Health Commercial |
$3.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.42
|
| Rate for Payer: Group Health Inc Commercial |
$2.52
|
| Rate for Payer: Group Health Inc Medicare |
$1.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.27
|
|
|
GRISEOFULVIN ULTRAMICROCRYSTALLINE 250 M
|
Facility
|
OP
|
$5.03
|
|
| Hospital Charge Code |
41643120
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.52
|
| Rate for Payer: Aetna Government |
$2.52
|
| Rate for Payer: Brighton Health Commercial |
$3.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.42
|
| Rate for Payer: Group Health Inc Commercial |
$2.52
|
| Rate for Payer: Group Health Inc Medicare |
$1.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.27
|
|
|
GRISEOFULVIN ULTRAMICROSIZE 250 MG PO TABS [3536]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 42794001408
|
| Hospital Charge Code |
42794001408
|
|
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
|
|
|
GROSS PULPAL DEBRIDE PRIME & PERM
|
Facility
|
IP
|
$219.71
|
|
|
Service Code
|
HCPCS D3221
|
| Hospital Charge Code |
42303300
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,018.19
|
|
|
GROSS PULPAL DEBRIDE PRIME & PERM
|
Facility
|
OP
|
$219.71
|
|
|
Service Code
|
HCPCS D3221
|
| Hospital Charge Code |
42303300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.86 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$120.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$712.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$712.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$712.73
|
| Rate for Payer: Brighton Health Commercial |
$164.78
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$109.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Humana Medicare |
$1,038.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
GROUNDING PADS
|
Facility
|
OP
|
$6.73
|
|
| Hospital Charge Code |
40000220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.36
|
| Rate for Payer: Aetna Government |
$3.36
|
| Rate for Payer: Brighton Health Commercial |
$5.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.58
|
| Rate for Payer: Group Health Inc Commercial |
$3.36
|
| Rate for Payer: Group Health Inc Medicare |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.36
|
|
|
GROUP II SPECIAL STAINS
|
Facility
|
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
40635451
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$74.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.52
|
| Rate for Payer: Brighton Health Commercial |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.74
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$63.67
|
|
|
GROUP II SPECIAL STAINS
|
Facility
|
IP
|
$101.25
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
40635451
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
GROUP II SPECIAL STAINS
|
Facility
|
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
40635450
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$74.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$49.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$49.52
|
| Rate for Payer: Brighton Health Commercial |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$70.74
|
| Rate for Payer: EmblemHealth Commercial |
$70.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| Rate for Payer: Group Health Inc Commercial |
$70.74
|
| Rate for Payer: Group Health Inc Medicare |
$70.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70.74
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: Humana Medicare |
$72.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$63.67
|
|
|
GROUP II SPECIAL STAINS
|
Facility
|
IP
|
$101.25
|
|
|
Service Code
|
HCPCS 88313
|
| Hospital Charge Code |
40635450
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$70.74
|
|
|
GROUP I SPECIAL STAINS
|
Facility
|
IP
|
$149.83
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
40635441
|
|
Hospital Revenue Code
|
312
|
| Rate for Payer: Cash Price |
$62.66
|
|
|
GROUP I SPECIAL STAINS
|
Facility
|
OP
|
$149.83
|
|
|
Service Code
|
HCPCS 88312
|
| Hospital Charge Code |
40635441
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$43.86 |
| Max. Negotiated Rate |
$90.96 |
| 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 |
$90.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.97
|
| 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
|
|
|
GROUP SESSION 15-30 MINUTES
|
Facility
|
OP
|
$69.60
|
|
|
Service Code
|
HCPCS 92508 GN
|
| Hospital Charge Code |
41903101
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.71
|
| Rate for Payer: Aetna Government |
$15.71
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Group Health Inc Commercial |
$34.80
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.80
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
GROUP SESSION 31-45 MINUTES
|
Facility
|
OP
|
$69.60
|
|
|
Service Code
|
HCPCS 92508 GN
|
| Hospital Charge Code |
41903102
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.71
|
| Rate for Payer: Aetna Government |
$15.71
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Group Health Inc Commercial |
$34.80
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.80
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
GROUP SESSION 45-60 MINUTES
|
Facility
|
OP
|
$69.60
|
|
|
Service Code
|
HCPCS 92508 GN
|
| Hospital Charge Code |
41903103
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.71
|
| Rate for Payer: Aetna Government |
$15.71
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Group Health Inc Commercial |
$34.80
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.80
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
GROUP THERAPY NOT MULTI FAMILY
|
Facility
|
OP
|
$237.88
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
30400093
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$6,747.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103.08
|
| Rate for Payer: Aetna Government |
$103.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$151.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$151.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.47
|
| Rate for Payer: Amida Care Medicaid |
$67.47
|
| Rate for Payer: Brighton Health Commercial |
$178.41
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$68.09
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$103.08
|
| Rate for Payer: EmblemHealth Commercial |
$103.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6,747.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.84
|
| Rate for Payer: Group Health Inc Commercial |
$103.08
|
| Rate for Payer: Group Health Inc Medicare |
$103.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.47
|
| Rate for Payer: Healthfirst Essential Plan |
$151.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.62
|
| Rate for Payer: Healthfirst QHP |
$67.47
|
| Rate for Payer: Humana Medicare |
$105.14
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$153.20
|
| Rate for Payer: Optum Commercial/Medicare |
$143.00
|
| Rate for Payer: Optum Medicaid |
$68.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.47
|
| Rate for Payer: SOMOS Essential |
$151.81
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$151.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$74.22
|
| Rate for Payer: United Healthcare Medicaid |
$67.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$103.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.46
|
| Rate for Payer: Wellcare Medicare |
$97.93
|
|
|
GROUP THERAPY NOT MULTI FAMILY
|
Facility
|
IP
|
$237.88
|
|
|
Service Code
|
HCPCS 90853
|
| Hospital Charge Code |
30400093
|
|
Hospital Revenue Code
|
905
|
| Rate for Payer: Cash Price |
$103.08
|
|
|
GROWTH HORMONE, SERUM
|
Facility
|
IP
|
$41.68
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
40609082
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$16.67
|
|
|
GROWTH HORMONE, SERUM
|
Facility
|
OP
|
$41.68
|
|
|
Service Code
|
HCPCS 83003
|
| Hospital Charge Code |
40609082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$31.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.67
|
| Rate for Payer: Aetna Government |
$16.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.67
|
| Rate for Payer: Brighton Health Commercial |
$31.26
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.67
|
| Rate for Payer: EmblemHealth Commercial |
$16.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.84
|
| Rate for Payer: Group Health Inc Commercial |
$16.67
|
| Rate for Payer: Group Health Inc Medicare |
$16.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.67
|
| Rate for Payer: Healthfirst QHP |
$16.67
|
| Rate for Payer: Humana Medicare |
$17.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.67
|
| Rate for Payer: United Healthcare Commercial |
$21.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.34
|
| Rate for Payer: Wellcare Medicare |
$15.00
|
|
