|
MOUTHPIECE PEDIATRIC
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
64905936
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Brighton Health Commercial |
$37.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.00
|
| Rate for Payer: Group Health Inc Commercial |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
|
|
MOUTHPIECE W/ ONE WAY VALVE
|
Facility
|
OP
|
$0.83
|
|
| Hospital Charge Code |
64901881
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$0.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.56
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
|
|
MOUTH PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$38,766.89
|
|
|
Service Code
|
MSDRG 137
|
| Min. Negotiated Rate |
$12,902.80 |
| Max. Negotiated Rate |
$38,766.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,186.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,194.10
|
| Rate for Payer: Aetna Government |
$28,194.10
|
| Rate for Payer: Brighton Health Commercial |
$21,818.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,757.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,984.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,443.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,784.40
|
| Rate for Payer: EmblemHealth Commercial |
$12,902.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,194.10
|
| Rate for Payer: Group Health Inc Commercial |
$28,194.10
|
| Rate for Payer: Group Health Inc Medicare |
$28,194.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,194.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,110.26
|
| Rate for Payer: Humana Medicare |
$38,766.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,194.10
|
| Rate for Payer: United Healthcare Commercial |
$29,923.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,194.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,194.10
|
| Rate for Payer: Wellcare Medicare |
$26,784.40
|
|
|
MOUTH PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,582.67
|
|
|
Service Code
|
MSDRG 138
|
| Min. Negotiated Rate |
$7,423.38 |
| Max. Negotiated Rate |
$26,582.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,764.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,332.85
|
| Rate for Payer: Aetna Government |
$19,332.85
|
| Rate for Payer: Brighton Health Commercial |
$12,552.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,719.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,949.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,337.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,366.21
|
| Rate for Payer: EmblemHealth Commercial |
$7,423.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,332.85
|
| Rate for Payer: Group Health Inc Commercial |
$19,332.85
|
| Rate for Payer: Group Health Inc Medicare |
$19,332.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,332.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,989.78
|
| Rate for Payer: Humana Medicare |
$26,582.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,332.85
|
| Rate for Payer: United Healthcare Commercial |
$17,216.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,332.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,332.85
|
| Rate for Payer: Wellcare Medicare |
$18,366.21
|
|
|
MOUTH REHAB
|
Facility
|
OP
|
$616.78
|
|
|
Service Code
|
HCPCS 41899
|
| Hospital Charge Code |
40011245
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$225.98 |
| Max. Negotiated Rate |
$142,987.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,217.21
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,217.21
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,429.87
|
| Rate for Payer: Amida Care Medicaid |
$1,429.87
|
| Rate for Payer: Brighton Health Commercial |
$462.58
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$282.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$142,987.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,429.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,429.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,501.36
|
| Rate for Payer: Group Health Inc Commercial |
$282.47
|
| Rate for Payer: Group Health Inc Medicare |
$282.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,429.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,429.87
|
| Rate for Payer: Healthfirst Essential Plan |
$3,217.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.10
|
| Rate for Payer: Healthfirst QHP |
$1,429.87
|
| Rate for Payer: Humana Medicare |
$288.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,429.87
|
| Rate for Payer: SOMOS Essential |
$3,217.21
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$3,217.21
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,572.86
|
| Rate for Payer: United Healthcare Medicaid |
$1,429.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
MOUTH REHAB
|
Facility
|
IP
|
$616.78
|
|
|
Service Code
|
HCPCS 41899
|
| Hospital Charge Code |
40011245
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$282.47
|
|
|
MOXIFLOXACIN 0.5% OPHTHALMIC SOLN
|
Facility
|
OP
|
$167.82
|
|
| Hospital Charge Code |
41653731
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.74 |
| Max. Negotiated Rate |
$134.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.91
|
| Rate for Payer: Aetna Government |
$83.91
|
| Rate for Payer: Brighton Health Commercial |
$125.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$134.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.12
|
| Rate for Payer: Group Health Inc Commercial |
$83.91
|
| Rate for Payer: Group Health Inc Medicare |
$58.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.08
|
|
|
MOXIFLOXACIN 0.5% OPHTHALMIC SOLN
|
Facility
|
OP
|
$167.82
|
|
| Hospital Charge Code |
41643731
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.74 |
| Max. Negotiated Rate |
$134.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.91
|
| Rate for Payer: Aetna Government |
$83.91
|
| Rate for Payer: Brighton Health Commercial |
$125.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$134.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.12
|
| Rate for Payer: Group Health Inc Commercial |
$83.91
|
| Rate for Payer: Group Health Inc Medicare |
$58.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$109.08
|
|
|
MOXIFLOXACIN 400MG/NACL 250ML(NF)
|
Facility
|
IP
|
$22.79
|
|
|
Service Code
|
HCPCS J2280
|
| Hospital Charge Code |
41656642
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.40
|
|
|
MOXIFLOXACIN 400MG/NACL 250ML(NF)
|
Facility
|
OP
|
$22.79
|
|
|
Service Code
|
HCPCS J2280
|
| Hospital Charge Code |
41656642
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$14.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.22
|
| Rate for Payer: Aetna Government |
$9.22
|
| Rate for Payer: Brighton Health Commercial |
$13.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.10
|
| Rate for Payer: Group Health Inc Commercial |
$11.40
|
| Rate for Payer: Group Health Inc Medicare |
$7.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.29
|
| Rate for Payer: SOMOS Essential |
$9.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
MOXIFLOXACIN 400MG/NACL 250ML(NF)
|
Facility
|
OP
|
$22.79
|
|
|
Service Code
|
HCPCS J2280
|
| Hospital Charge Code |
41646642
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$14.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.22
|
| Rate for Payer: Aetna Government |
$9.22
|
| Rate for Payer: Brighton Health Commercial |
$13.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.10
|
| Rate for Payer: Group Health Inc Commercial |
$11.40
|
| Rate for Payer: Group Health Inc Medicare |
$7.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.29
|
| Rate for Payer: SOMOS Essential |
$9.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.81
|
|
|
MOXIFLOXACIN 400MG/NACL 250ML(NF)
|
Facility
|
IP
|
$22.79
|
|
|
Service Code
|
HCPCS J2280
|
| Hospital Charge Code |
41646642
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$11.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.40
|
|
|
MOXIFLOXACIN 400MG TAB (NF)
|
Facility
|
OP
|
$20.55
|
|
| Hospital Charge Code |
41656641
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$16.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.28
|
| Rate for Payer: Aetna Government |
$10.28
|
| Rate for Payer: Brighton Health Commercial |
$15.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.97
|
| Rate for Payer: Group Health Inc Commercial |
$10.28
|
| Rate for Payer: Group Health Inc Medicare |
$7.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.36
|
|
|
MOXIFLOXACIN 400MG TAB (NF)
|
Facility
|
OP
|
$20.55
|
|
| Hospital Charge Code |
41646641
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.19 |
| Max. Negotiated Rate |
$16.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.28
|
| Rate for Payer: Aetna Government |
$10.28
|
| Rate for Payer: Brighton Health Commercial |
$15.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.97
|
| Rate for Payer: Group Health Inc Commercial |
$10.28
|
| Rate for Payer: Group Health Inc Medicare |
$7.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.36
|
|
|
MOXIFLOXACIN HCL 0.5 % OP SOLN [35699]
|
Facility
|
OP
|
$55.78
|
|
|
Service Code
|
NDC 60505058204
|
| Hospital Charge Code |
60505058204
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$44.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.89
|
| Rate for Payer: Aetna Government |
$27.89
|
| Rate for Payer: Brighton Health Commercial |
$41.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.93
|
| Rate for Payer: Group Health Inc Commercial |
$27.89
|
| Rate for Payer: Group Health Inc Medicare |
$19.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.26
|
|
|
MOXIFLOXACIN HCL 400 MG/250ML IV SOLN [130055]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
HCPCS J2280
|
| Hospital Charge Code |
63323085074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.22
|
| Rate for Payer: Aetna Government |
$9.22
|
| Rate for Payer: Brighton Health Commercial |
$0.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: EmblemHealth Commercial |
$0.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.23
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
MOXIFLOXACIN HCL 400 MG/250ML IV SOLN [130055]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
HCPCS J2280
|
| Hospital Charge Code |
63323085074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
|
|
MOXIFLOXACIN HCL 400 MG PO TABS [26854]
|
Facility
|
OP
|
$27.23
|
|
|
Service Code
|
NDC 65862060330
|
| Hospital Charge Code |
65862060330
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$21.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.61
|
| Rate for Payer: Aetna Government |
$13.61
|
| Rate for Payer: Brighton Health Commercial |
$20.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.51
|
| Rate for Payer: Group Health Inc Commercial |
$13.61
|
| Rate for Payer: Group Health Inc Medicare |
$9.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.70
|
|
|
MOXIFLOXACIN HCL IN NACL 400 MG/250ML IV SOLN [31906]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
HCPCS J2280
|
| Hospital Charge Code |
67457032325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.22
|
| Rate for Payer: Aetna Government |
$9.22
|
| Rate for Payer: Brighton Health Commercial |
$0.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: EmblemHealth Commercial |
$0.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.23
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
MOXIFLOXACIN HCL IN NACL 400 MG/250ML IV SOLN [31906]
|
Facility
|
IP
|
$0.22
|
|
|
Service Code
|
HCPCS J2280
|
| Hospital Charge Code |
67457032325
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
|
|
MP E.R SCREW C-PIN 2.3 X 10 MM
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$59.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.00
|
|
|
MP E.R SCREW C-PIN 2.3 X 10 MM
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201249
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$70.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.85
|
| Rate for Payer: EmblemHealth Commercial |
$59.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$123.90
|
| Rate for Payer: Group Health Inc Commercial |
$59.00
|
| Rate for Payer: Group Health Inc Medicare |
$41.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$76.70
|
|
|
MP E.R SCREW C-PIN 2.3 X 12 MM
|
Facility
|
OP
|
$131.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.91 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$78.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.43
|
| Rate for Payer: EmblemHealth Commercial |
$65.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.74
|
| Rate for Payer: Group Health Inc Commercial |
$65.59
|
| Rate for Payer: Group Health Inc Medicare |
$45.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.27
|
|
|
MP E.R SCREW C-PIN 2.3 X 12 MM
|
Facility
|
IP
|
$131.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$65.59 |
| Max. Negotiated Rate |
$65.59 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.59
|
|
|
MP E.R SCREW C-PIN 2.3 X 14 MM
|
Facility
|
OP
|
$131.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201251
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$45.91 |
| Max. Negotiated Rate |
$137.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$72.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$78.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$75.43
|
| Rate for Payer: EmblemHealth Commercial |
$65.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$137.74
|
| Rate for Payer: Group Health Inc Commercial |
$65.59
|
| Rate for Payer: Group Health Inc Medicare |
$45.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$85.27
|
|
