|
LITHIUM CITRATE 300 MG/5 ML SYRUP UDC
|
Facility
|
OP
|
$1.06
|
|
| Hospital Charge Code |
41651130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna Government |
$0.53
|
| Rate for Payer: Brighton Health Commercial |
$0.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.72
|
| Rate for Payer: Group Health Inc Commercial |
$0.53
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.69
|
|
|
LITHIUM CITRATE 300 MG/5 ML SYRUP UDC
|
Facility
|
OP
|
$1.06
|
|
| Hospital Charge Code |
41641130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna Government |
$0.53
|
| Rate for Payer: Brighton Health Commercial |
$0.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.72
|
| Rate for Payer: Group Health Inc Commercial |
$0.53
|
| Rate for Payer: Group Health Inc Medicare |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.69
|
|
|
LITHIUM CITRATE 600 MG/10 ML SYRUP UDC
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41643468
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
LITHIUM CITRATE 600 MG/10 ML SYRUP UDC
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41653468
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
LITHIUM (ESKALITH(R)) SERUM
|
Facility
|
OP
|
$16.53
|
|
|
Service Code
|
HCPCS 80178
|
| Hospital Charge Code |
40609717
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$12.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.61
|
| Rate for Payer: Aetna Government |
$6.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.63
|
| Rate for Payer: Brighton Health Commercial |
$12.40
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.61
|
| Rate for Payer: EmblemHealth Commercial |
$6.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.88
|
| Rate for Payer: Group Health Inc Commercial |
$6.61
|
| Rate for Payer: Group Health Inc Medicare |
$6.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.61
|
| Rate for Payer: Healthfirst QHP |
$6.61
|
| Rate for Payer: Humana Medicare |
$6.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.61
|
| Rate for Payer: United Healthcare Commercial |
$8.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.29
|
| Rate for Payer: Wellcare Medicare |
$5.95
|
|
|
LITHIUM (ESKALITH(R)) SERUM
|
Facility
|
IP
|
$16.53
|
|
|
Service Code
|
HCPCS 80178
|
| Hospital Charge Code |
40609717
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$6.61
|
|
|
Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large (over 2.5 cm)
|
Facility
|
OP
|
$4,112.10
|
|
|
Service Code
|
CPT 52318
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$4,112.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,031.47
|
| Rate for Payer: Aetna Government |
$4,031.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,822.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,822.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,822.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,031.47
|
| 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 |
$4,031.47
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,426.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,588.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,031.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,588.01
|
| Rate for Payer: Group Health Inc Commercial |
$4,031.47
|
| Rate for Payer: Group Health Inc Medicare |
$4,031.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,031.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,426.75
|
| Rate for Payer: Healthfirst QHP |
$4,031.47
|
| Rate for Payer: Humana Medicare |
$4,112.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,031.47
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,031.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,031.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,225.18
|
| Rate for Payer: Wellcare Medicare |
$3,829.90
|
|
|
LITHOTRIPSY
|
Facility
|
OP
|
$12,816.53
|
|
|
Service Code
|
HCPCS 52353
|
| Hospital Charge Code |
40123100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$9,612.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,983.74
|
| Rate for Payer: Aetna Government |
$5,983.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,188.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,188.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,188.62
|
| Rate for Payer: Brighton Health Commercial |
$9,612.40
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,983.74
|
| 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 |
$5,983.74
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,086.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,325.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,983.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,325.53
|
| Rate for Payer: Group Health Inc Commercial |
$5,983.74
|
| Rate for Payer: Group Health Inc Medicare |
$5,983.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,408.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,983.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,086.18
|
| Rate for Payer: Healthfirst QHP |
$5,983.74
|
| Rate for Payer: Humana Medicare |
$6,103.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,983.74
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,983.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,983.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,786.99
|
| Rate for Payer: Wellcare Medicare |
$5,684.55
|
|
|
LITHOTRIPSY
|
Facility
|
IP
|
$12,816.53
|
|
|
Service Code
|
HCPCS 52353
|
| Hospital Charge Code |
40123100
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,983.74
|
|
|
LITHOTRIPSY BLADDER
|
Facility
|
IP
|
$12,816.53
|
|
|
Service Code
|
HCPCS 52353
|
| Hospital Charge Code |
40019527
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$5,983.74
|
|
|
LITHOTRIPSY BLADDER
|
Facility
|
OP
|
$12,816.53
|
|
|
Service Code
|
HCPCS 52353
|
| Hospital Charge Code |
40019527
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$9,612.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,983.74
|
| Rate for Payer: Aetna Government |
$5,983.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,188.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,188.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,188.62
|
| Rate for Payer: Brighton Health Commercial |
$9,612.40
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Cash Price |
$5,983.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5,983.74
|
| 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 |
$5,983.74
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,086.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,325.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,983.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,325.53
|
| Rate for Payer: Group Health Inc Commercial |
$5,983.74
|
| Rate for Payer: Group Health Inc Medicare |
$5,983.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,408.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,983.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,086.18
|
| Rate for Payer: Healthfirst QHP |
$5,983.74
|
| Rate for Payer: Humana Medicare |
$6,103.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5,983.74
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,983.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,983.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,786.99
|
| Rate for Payer: Wellcare Medicare |
$5,684.55
|
|
|
LITHOTRIPSY FIBR150 MICRON LASER
|
Facility
|
OP
|
$968.00
|
|
| Hospital Charge Code |
40200893
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$338.80 |
| Max. Negotiated Rate |
$774.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$532.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$484.00
|
| Rate for Payer: Aetna Government |
$484.00
|
| Rate for Payer: Brighton Health Commercial |
$726.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$774.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$658.24
|
| Rate for Payer: Group Health Inc Commercial |
$484.00
|
| Rate for Payer: Group Health Inc Medicare |
$338.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$484.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$484.00
|
|
|
LITHOTRIPSY LASER
|
Facility
|
OP
|
$2,140.00
|
|
| Hospital Charge Code |
40200892
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$749.00 |
| Max. Negotiated Rate |
$1,712.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,177.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,070.00
|
| Rate for Payer: Aetna Government |
$1,070.00
|
| Rate for Payer: Brighton Health Commercial |
$1,605.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,712.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,455.20
|
| Rate for Payer: Group Health Inc Commercial |
$1,070.00
|
| Rate for Payer: Group Health Inc Medicare |
$749.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,070.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,070.00
|
|
|
LITHOTRIPSY PANCREATIC DUCT
|
Facility
|
IP
|
$14,479.95
|
|
|
Service Code
|
HCPCS 43265
|
| Hospital Charge Code |
40019528
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,590.73
|
|
|
LITHOTRIPSY PANCREATIC DUCT
|
Facility
|
OP
|
$14,479.95
|
|
|
Service Code
|
HCPCS 43265
|
| Hospital Charge Code |
40019528
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$955.00 |
| Max. Negotiated Rate |
$7,239.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,590.73
|
| Rate for Payer: Aetna Government |
$6,590.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,613.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,613.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,613.51
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$6,590.73
|
| Rate for Payer: Cash Price |
$6,590.73
|
| Rate for Payer: Cash Price |
$6,590.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,590.73
|
| 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 |
$6,590.73
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,602.12
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,865.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,590.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,865.75
|
| Rate for Payer: Group Health Inc Commercial |
$6,590.73
|
| Rate for Payer: Group Health Inc Medicare |
$6,590.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,239.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,590.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,602.12
|
| Rate for Payer: Healthfirst QHP |
$6,590.73
|
| Rate for Payer: Humana Medicare |
$6,722.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,590.73
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,590.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,590.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,272.58
|
| Rate for Payer: Wellcare Medicare |
$6,261.19
|
|
|
LITTLE C ANTIGEN TYPE
|
Facility
|
IP
|
$182.44
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701257
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$415.67
|
|
|
LITTLE C ANTIGEN TYPE
|
Facility
|
OP
|
$182.44
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$423.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$415.67
|
| Rate for Payer: Aetna Government |
$415.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$290.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$290.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$290.97
|
| Rate for Payer: Brighton Health Commercial |
$136.83
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$415.67
|
| Rate for Payer: EmblemHealth Commercial |
$415.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.95
|
| Rate for Payer: Group Health Inc Commercial |
$415.67
|
| Rate for Payer: Group Health Inc Medicare |
$415.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.67
|
| Rate for Payer: Healthfirst QHP |
$415.67
|
| Rate for Payer: Humana Medicare |
$423.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.67
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$332.54
|
| Rate for Payer: Wellcare Medicare |
$374.10
|
|
|
LITTLE E ANTIGEN TYPE
|
Facility
|
OP
|
$182.44
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701258
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$423.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$415.67
|
| Rate for Payer: Aetna Government |
$415.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$290.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$290.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$290.97
|
| Rate for Payer: Brighton Health Commercial |
$136.83
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$415.67
|
| Rate for Payer: EmblemHealth Commercial |
$415.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.95
|
| Rate for Payer: Group Health Inc Commercial |
$415.67
|
| Rate for Payer: Group Health Inc Medicare |
$415.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.67
|
| Rate for Payer: Healthfirst QHP |
$415.67
|
| Rate for Payer: Humana Medicare |
$423.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.67
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$332.54
|
| Rate for Payer: Wellcare Medicare |
$374.10
|
|
|
LITTLE E ANTIGEN TYPE
|
Facility
|
IP
|
$182.44
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701258
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$415.67
|
|
|
LITTLER SUTURE CARRING SCS CRVD
|
Facility
|
OP
|
$87.38
|
|
| Hospital Charge Code |
64905649
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$69.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.69
|
| Rate for Payer: Aetna Government |
$43.69
|
| Rate for Payer: Brighton Health Commercial |
$65.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$69.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.42
|
| Rate for Payer: Group Health Inc Commercial |
$43.69
|
| Rate for Payer: Group Health Inc Medicare |
$30.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.69
|
|
|
LITTLE S ANTIGEN
|
Facility
|
IP
|
$858.38
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701263
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$415.67
|
|
|
LITTLE S ANTIGEN
|
Facility
|
OP
|
$858.38
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701263
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$643.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$472.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$415.67
|
| Rate for Payer: Aetna Government |
$415.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$290.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$290.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$290.97
|
| Rate for Payer: Brighton Health Commercial |
$643.78
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$415.67
|
| Rate for Payer: EmblemHealth Commercial |
$415.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.95
|
| Rate for Payer: Group Health Inc Commercial |
$415.67
|
| Rate for Payer: Group Health Inc Medicare |
$415.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.67
|
| Rate for Payer: Healthfirst QHP |
$415.67
|
| Rate for Payer: Humana Medicare |
$423.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.67
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$332.54
|
| Rate for Payer: Wellcare Medicare |
$374.10
|
|
|
LIVER KIDNEY MICROSOMAL AB
|
Facility
|
IP
|
$36.38
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
40728159
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$14.55
|
|
|
LIVER KIDNEY MICROSOMAL AB
|
Facility
|
OP
|
$36.38
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
40728159
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$27.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.55
|
| Rate for Payer: Aetna Government |
$14.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.18
|
| Rate for Payer: Brighton Health Commercial |
$27.28
|
| Rate for Payer: Cash Price |
$14.55
|
| Rate for Payer: Cash Price |
$14.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.55
|
| Rate for Payer: EmblemHealth Commercial |
$14.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.95
|
| Rate for Payer: Group Health Inc Commercial |
$14.55
|
| Rate for Payer: Group Health Inc Medicare |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.55
|
| Rate for Payer: Healthfirst QHP |
$14.55
|
| Rate for Payer: Humana Medicare |
$14.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.55
|
| Rate for Payer: United Healthcare Commercial |
$18.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.64
|
| Rate for Payer: Wellcare Medicare |
$13.10
|
|
|
LIVER-KIDNEY MICROSOMAL AB
|
Facility
|
IP
|
$36.38
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
40729345
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$14.55
|
|
