|
LINEZOLID 600 MG/300ML IV SOLN [131499]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
00781343346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.62
|
| Rate for Payer: Aetna Government |
$6.62
|
| Rate for Payer: Brighton Health Commercial |
$0.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: EmblemHealth Commercial |
$0.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
LINEZOLID 600 MG PO TABS [28224]
|
Facility
|
OP
|
$183.66
|
|
|
Service Code
|
NDC 67877041920
|
| Hospital Charge Code |
67877041920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.28 |
| Max. Negotiated Rate |
$146.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.83
|
| Rate for Payer: Aetna Government |
$91.83
|
| Rate for Payer: Brighton Health Commercial |
$137.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.89
|
| Rate for Payer: Group Health Inc Commercial |
$91.83
|
| Rate for Payer: Group Health Inc Medicare |
$64.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.38
|
|
|
LINEZOLID 600 MG PO TABS [28224]
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
NDC 00904655304
|
| Hospital Charge Code |
00904655304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.05 |
| Max. Negotiated Rate |
$146.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.50
|
| Rate for Payer: Aetna Government |
$91.50
|
| Rate for Payer: Brighton Health Commercial |
$137.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.44
|
| Rate for Payer: Group Health Inc Commercial |
$91.50
|
| Rate for Payer: Group Health Inc Medicare |
$64.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.95
|
|
|
LINEZOLID 600 MG PO TABS [28224]
|
Facility
|
OP
|
$183.67
|
|
|
Service Code
|
NDC 59762130702
|
| Hospital Charge Code |
59762130702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.29 |
| Max. Negotiated Rate |
$146.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$101.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$91.84
|
| Rate for Payer: Aetna Government |
$91.84
|
| Rate for Payer: Brighton Health Commercial |
$137.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.90
|
| Rate for Payer: Group Health Inc Commercial |
$91.84
|
| Rate for Payer: Group Health Inc Medicare |
$64.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$91.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$119.39
|
|
|
LINEZOLID 600 MG TAB
|
Facility
|
OP
|
$177.67
|
|
| Hospital Charge Code |
41652317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.18 |
| Max. Negotiated Rate |
$142.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$88.84
|
| Rate for Payer: Aetna Government |
$88.84
|
| Rate for Payer: Brighton Health Commercial |
$133.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$142.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$120.82
|
| Rate for Payer: Group Health Inc Commercial |
$88.84
|
| Rate for Payer: Group Health Inc Medicare |
$62.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.49
|
|
|
LINEZOLID 600 MG TAB
|
Facility
|
OP
|
$177.67
|
|
| Hospital Charge Code |
41642317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.18 |
| Max. Negotiated Rate |
$142.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$97.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$88.84
|
| Rate for Payer: Aetna Government |
$88.84
|
| Rate for Payer: Brighton Health Commercial |
$133.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$142.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$120.82
|
| Rate for Payer: Group Health Inc Commercial |
$88.84
|
| Rate for Payer: Group Health Inc Medicare |
$62.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$88.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$115.49
|
|
|
LINGUAL FRENECTOMY
|
Facility
|
OP
|
$217.50
|
|
|
Service Code
|
HCPCS D7962
|
| Hospital Charge Code |
42302092
|
|
Hospital Revenue Code
|
512
|
| Min. Negotiated Rate |
$108.75 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$161.83
|
| Rate for Payer: Aetna Government |
$161.83
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$108.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.75
|
|
|
LINVATEC SUTURE ANCHOR 4.5MM
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$289.00 |
| Max. Negotiated Rate |
$289.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$289.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$289.00
|
|
|
LINVATEC SUTURE ANCHOR 4.5MM
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205529
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$606.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$317.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$346.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$289.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$332.35
|
| Rate for Payer: EmblemHealth Commercial |
$289.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$606.90
|
| Rate for Payer: Group Health Inc Commercial |
$289.00
|
| Rate for Payer: Group Health Inc Medicare |
$202.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$289.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$289.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$375.70
|
|
|
LINVATEC ULTAFIX RC ANCHOR
|
Facility
|
OP
|
$422.00
|
|
| Hospital Charge Code |
40208084
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$147.70 |
| Max. Negotiated Rate |
$337.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$232.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$211.00
|
| Rate for Payer: Aetna Government |
$211.00
|
| Rate for Payer: Brighton Health Commercial |
$316.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$337.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$286.96
|
| Rate for Payer: Group Health Inc Commercial |
$211.00
|
| Rate for Payer: Group Health Inc Medicare |
$147.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$211.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$211.00
|
|
|
LIORESAL INTRATHECAL REFILL KIT
|
Facility
|
OP
|
$1,720.00
|
|
| Hospital Charge Code |
40206086
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$602.00 |
| Max. Negotiated Rate |
$1,376.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$946.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$860.00
|
| Rate for Payer: Aetna Government |
$860.00
|
| Rate for Payer: Brighton Health Commercial |
$1,290.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,376.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,169.60
|
| Rate for Payer: Group Health Inc Commercial |
$860.00
|
| Rate for Payer: Group Health Inc Medicare |
$602.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$860.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$860.00
|
|
|
LIOTHYRONINE 25 MCG TAB
|
Facility
|
OP
|
$2.33
|
|
| Hospital Charge Code |
41654310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.16
|
| Rate for Payer: Aetna Government |
$1.16
|
| Rate for Payer: Brighton Health Commercial |
$1.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.58
|
| Rate for Payer: Group Health Inc Commercial |
$1.16
|
| Rate for Payer: Group Health Inc Medicare |
$0.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.51
|
|
|
LIOTHYRONINE 25 MCG TAB
|
Facility
|
OP
|
$2.33
|
|
| Hospital Charge Code |
41644310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.16
|
| Rate for Payer: Aetna Government |
$1.16
|
| Rate for Payer: Brighton Health Commercial |
$1.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.58
|
| Rate for Payer: Group Health Inc Commercial |
$1.16
|
| Rate for Payer: Group Health Inc Medicare |
$0.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.51
|
|
|
LIOTHYRONINE 5 MCG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41654050
|
|
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
|
|
|
LIOTHYRONINE 5 MCG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41644050
|
|
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
|
|
|
LIOTHYRONINE SODIUM 25 MCG PO TABS [4504]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
NDC 62756059088
|
| Hospital Charge Code |
62756059088
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.52
|
| Rate for Payer: Aetna Government |
$0.52
|
| Rate for Payer: Brighton Health Commercial |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.71
|
| Rate for Payer: Group Health Inc Commercial |
$0.52
|
| Rate for Payer: Group Health Inc Medicare |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.68
|
|
|
LIOTHYRONINE SODIUM 5 MCG PO TABS [10443]
|
Facility
|
OP
|
$0.79
|
|
|
Service Code
|
NDC 62756058988
|
| Hospital Charge Code |
62756058988
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$0.63 |
| 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 |
$0.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.63
|
| 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 |
$0.51
|
|
|
LIOTHYRONINE SODIUM 5 MCG PO TABS [10443]
|
Facility
|
OP
|
$1.89
|
|
|
Service Code
|
NDC 51862032001
|
| Hospital Charge Code |
51862032001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.95
|
| Rate for Payer: Aetna Government |
$0.95
|
| Rate for Payer: Brighton Health Commercial |
$1.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.95
|
| Rate for Payer: Group Health Inc Medicare |
$0.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.23
|
|
|
LIPASE
|
Facility
|
IP
|
$17.23
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
40602175
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$6.89
|
|
|
LIPASE
|
Facility
|
OP
|
$17.23
|
|
|
Service Code
|
HCPCS 83690
|
| Hospital Charge Code |
40602175
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.89
|
| Rate for Payer: Aetna Government |
$6.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.82
|
| Rate for Payer: Brighton Health Commercial |
$12.92
|
| Rate for Payer: Cash Price |
$6.89
|
| Rate for Payer: Cash Price |
$6.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.89
|
| Rate for Payer: EmblemHealth Commercial |
$6.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.13
|
| Rate for Payer: Group Health Inc Commercial |
$6.89
|
| Rate for Payer: Group Health Inc Medicare |
$6.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.89
|
| Rate for Payer: Healthfirst QHP |
$6.89
|
| Rate for Payer: Humana Medicare |
$7.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.89
|
| Rate for Payer: United Healthcare Commercial |
$8.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.51
|
| Rate for Payer: Wellcare Medicare |
$6.20
|
|
|
LIPID_PANEL
|
Facility
|
OP
|
$33.48
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
40609000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.39
|
| Rate for Payer: Aetna Government |
$13.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.37
|
| Rate for Payer: Brighton Health Commercial |
$25.11
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.39
|
| Rate for Payer: EmblemHealth Commercial |
$13.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.92
|
| Rate for Payer: Group Health Inc Commercial |
$13.39
|
| Rate for Payer: Group Health Inc Medicare |
$13.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.39
|
| Rate for Payer: Healthfirst QHP |
$13.39
|
| Rate for Payer: Humana Medicare |
$13.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$16.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.71
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
|
|
LIPID_PANEL
|
Facility
|
IP
|
$33.48
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
40609000
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.39
|
|
|
LIPID PROFILE
|
Facility
|
OP
|
$33.48
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
40602475
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.39
|
| Rate for Payer: Aetna Government |
$13.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.37
|
| Rate for Payer: Brighton Health Commercial |
$25.11
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.39
|
| Rate for Payer: EmblemHealth Commercial |
$13.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.92
|
| Rate for Payer: Group Health Inc Commercial |
$13.39
|
| Rate for Payer: Group Health Inc Medicare |
$13.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.39
|
| Rate for Payer: Healthfirst QHP |
$13.39
|
| Rate for Payer: Humana Medicare |
$13.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$16.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.71
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
|
|
LIPID PROFILE
|
Facility
|
IP
|
$33.48
|
|
|
Service Code
|
HCPCS 80061
|
| Hospital Charge Code |
40602475
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$13.39
|
|
|
LIPOPROTEIN_(A)
|
Facility
|
OP
|
$35.80
|
|
|
Service Code
|
HCPCS 83695
|
| Hospital Charge Code |
40609740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$26.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$26.85
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.74
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.32
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Wellcare Medicare |
$12.89
|
|
