|
IV SET T-CONNECTOR PED EXTENSION
|
Facility
|
OP
|
$6.43
|
|
| Hospital Charge Code |
64902439
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$5.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.22
|
| Rate for Payer: Aetna Government |
$3.22
|
| Rate for Payer: Brighton Health Commercial |
$4.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.37
|
| Rate for Payer: Group Health Inc Commercial |
$3.22
|
| Rate for Payer: Group Health Inc Medicare |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.22
|
|
|
IV US FIRST VESSEL ADD-ON
|
Facility
|
OP
|
$2,536.83
|
|
|
Service Code
|
HCPCS 37252
|
| Hospital Charge Code |
30300161
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.71 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103.71
|
| Rate for Payer: Aetna Government |
$103.71
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,268.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,268.42
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
IZPRONGED MANIFOLD
|
Facility
|
OP
|
$10.64
|
|
| Hospital Charge Code |
42905230
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.32
|
| Rate for Payer: Aetna Government |
$5.32
|
| Rate for Payer: Brighton Health Commercial |
$7.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.24
|
| Rate for Payer: Group Health Inc Commercial |
$5.32
|
| Rate for Payer: Group Health Inc Medicare |
$3.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.32
|
|
|
JACKET WARM-UP LARGE
|
Facility
|
OP
|
$3.10
|
|
| Hospital Charge Code |
64902454
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.55
|
| Rate for Payer: Aetna Government |
$1.55
|
| Rate for Payer: Brighton Health Commercial |
$2.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.11
|
| Rate for Payer: Group Health Inc Commercial |
$1.55
|
| Rate for Payer: Group Health Inc Medicare |
$1.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.55
|
|
|
JAGTAIL GUIDEWIRE EXT .035X200CM
|
Facility
|
OP
|
$880.00
|
|
| Hospital Charge Code |
40209767
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$704.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$484.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$440.00
|
| Rate for Payer: Aetna Government |
$440.00
|
| Rate for Payer: Brighton Health Commercial |
$660.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$704.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$598.40
|
| Rate for Payer: Group Health Inc Commercial |
$440.00
|
| Rate for Payer: Group Health Inc Medicare |
$308.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$440.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$440.00
|
|
|
JAGWIRE HYDRAJAG .035/260CM STR
|
Facility
|
OP
|
$840.00
|
|
| Hospital Charge Code |
40200888
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$462.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$420.00
|
| Rate for Payer: Aetna Government |
$420.00
|
| Rate for Payer: Brighton Health Commercial |
$630.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$672.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$571.20
|
| Rate for Payer: Group Health Inc Commercial |
$420.00
|
| Rate for Payer: Group Health Inc Medicare |
$294.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$420.00
|
|
|
JAGWIRE HYDRAJAG .035/260CM STR
|
Facility
|
OP
|
$576.49
|
|
| Hospital Charge Code |
64904286
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$201.77 |
| Max. Negotiated Rate |
$461.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$317.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$288.24
|
| Rate for Payer: Aetna Government |
$288.24
|
| Rate for Payer: Brighton Health Commercial |
$432.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$461.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$392.01
|
| Rate for Payer: Group Health Inc Commercial |
$288.24
|
| Rate for Payer: Group Health Inc Medicare |
$201.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$288.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$288.24
|
|
|
JAK2 GENE
|
Facility
|
OP
|
$229.15
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
30305421
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.16 |
| Max. Negotiated Rate |
$183.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$126.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.66
|
| Rate for Payer: Aetna Government |
$91.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$64.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$64.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$64.16
|
| Rate for Payer: Brighton Health Commercial |
$91.66
|
| Rate for Payer: Cash Price |
$91.66
|
| Rate for Payer: Cash Price |
$91.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$91.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$183.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$155.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$91.66
|
| Rate for Payer: EmblemHealth Commercial |
$91.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$77.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$81.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$91.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$81.58
|
| Rate for Payer: Group Health Inc Commercial |
$91.66
|
| Rate for Payer: Group Health Inc Medicare |
$91.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.66
|
| Rate for Payer: Healthfirst QHP |
$91.66
|
| Rate for Payer: Humana Medicare |
$93.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$91.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$91.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$73.33
|
| Rate for Payer: Wellcare Medicare |
$82.49
|
|
|
JAK2 GENE
|
Facility
|
IP
|
$229.15
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
30305421
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$91.66
|
|
|
JAR COPLIN STAINING
|
Facility
|
OP
|
$17.13
|
|
| Hospital Charge Code |
64902591
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$13.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.56
|
| Rate for Payer: Aetna Government |
$8.56
|
| Rate for Payer: Brighton Health Commercial |
$12.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.65
|
| Rate for Payer: Group Health Inc Commercial |
$8.56
|
| Rate for Payer: Group Health Inc Medicare |
$6.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.56
|
|
|
JAW 4 IMPLANT
|
Facility
|
OP
|
$2,640.00
|
|
| Hospital Charge Code |
40203104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$924.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,452.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,320.00
|
| Rate for Payer: Aetna Government |
$1,320.00
|
| Rate for Payer: Brighton Health Commercial |
$1,980.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,112.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,795.20
|
| Rate for Payer: Group Health Inc Commercial |
$1,320.00
|
| Rate for Payer: Group Health Inc Medicare |
$924.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,320.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,320.00
|
|
|
JAW RADICAL 4 STANDARD CAPACITY
|
Facility
|
OP
|
$21.25
|
|
| Hospital Charge Code |
64905185
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.62
|
| Rate for Payer: Aetna Government |
$10.62
|
| Rate for Payer: Brighton Health Commercial |
$15.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.45
|
| Rate for Payer: Group Health Inc Commercial |
$10.62
|
| Rate for Payer: Group Health Inc Medicare |
$7.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.62
|
|
|
JC VIRUS DETECT. PCR
|
Facility
|
IP
|
$42.23
|
|
|
Service Code
|
HCPCS 86711
|
| Hospital Charge Code |
40728158
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$16.89
|
|
|
JC VIRUS DETECT. PCR
|
Facility
|
OP
|
$42.23
|
|
|
Service Code
|
HCPCS 86711
|
| Hospital Charge Code |
40728158
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$33.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.89
|
| Rate for Payer: Aetna Government |
$16.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.82
|
| Rate for Payer: Brighton Health Commercial |
$31.67
|
| Rate for Payer: Cash Price |
$16.89
|
| Rate for Payer: Cash Price |
$16.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.89
|
| Rate for Payer: EmblemHealth Commercial |
$16.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.03
|
| Rate for Payer: Group Health Inc Commercial |
$16.89
|
| Rate for Payer: Group Health Inc Medicare |
$16.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.89
|
| Rate for Payer: Healthfirst QHP |
$16.89
|
| Rate for Payer: Humana Medicare |
$17.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.89
|
| Rate for Payer: United Healthcare Commercial |
$17.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.51
|
| Rate for Payer: Wellcare Medicare |
$15.20
|
|
|
JC VIRUS DNA, PCR (CSF)
|
Facility
|
OP
|
$87.73
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
40729400
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$65.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.80
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
JC VIRUS DNA, PCR (CSF)
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
HCPCS 87798
|
| Hospital Charge Code |
40729400
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$35.09
|
|
|
JC VIRUS DNA, QN, CSF
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
30303379
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$80.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.84
|
| Rate for Payer: Aetna Government |
$42.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$29.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$29.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.99
|
| Rate for Payer: Brighton Health Commercial |
$80.32
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$42.84
|
| Rate for Payer: EmblemHealth Commercial |
$42.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.13
|
| Rate for Payer: Group Health Inc Commercial |
$42.84
|
| Rate for Payer: Group Health Inc Medicare |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.84
|
| Rate for Payer: Healthfirst QHP |
$42.84
|
| Rate for Payer: Humana Medicare |
$43.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$54.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.27
|
| Rate for Payer: Wellcare Medicare |
$38.56
|
|
|
JC VIRUS DNA, QN, CSF
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
HCPCS 87799
|
| Hospital Charge Code |
30303379
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$42.84
|
|
|
JELCO I.V. NEEDLE
|
Facility
|
OP
|
$6.73
|
|
| Hospital Charge Code |
40203040
|
|
Hospital Revenue Code
|
270
|
| 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
|
|
|
JELLY,LUBE,STERILE
|
Facility
|
OP
|
$0.08
|
|
| Hospital Charge Code |
64901981
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
|
|
JELLY PETROLEUM 5GM
|
Facility
|
OP
|
$0.15
|
|
| Hospital Charge Code |
64901100
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
|
|
JESSNERS EX SOLN [93611]
|
Facility
|
OP
|
$0.29
|
|
|
Service Code
|
NDC 51552086506
|
| Hospital Charge Code |
51552086506
|
|
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 |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| 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 |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.19
|
|
|
JESSNERS SOL 473ML
|
Facility
|
OP
|
$73.00
|
|
| Hospital Charge Code |
41658007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.55 |
| Max. Negotiated Rate |
$58.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.50
|
| Rate for Payer: Aetna Government |
$36.50
|
| Rate for Payer: Brighton Health Commercial |
$54.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$58.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.64
|
| Rate for Payer: Group Health Inc Commercial |
$36.50
|
| Rate for Payer: Group Health Inc Medicare |
$25.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.45
|
|
|
JESSNERS SOL 473ML
|
Facility
|
OP
|
$73.00
|
|
| Hospital Charge Code |
41648007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.55 |
| Max. Negotiated Rate |
$58.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.50
|
| Rate for Payer: Aetna Government |
$36.50
|
| Rate for Payer: Brighton Health Commercial |
$54.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$58.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.64
|
| Rate for Payer: Group Health Inc Commercial |
$36.50
|
| Rate for Payer: Group Health Inc Medicare |
$25.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.45
|
|
|
JIG KNOB
|
Facility
|
IP
|
$384.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40006124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$192.00
|
|
