|
MSL/MWT, GLOBAL
|
Facility
|
OP
|
$1,470.80
|
|
|
Service Code
|
HCPCS 95805 TC
|
| Hospital Charge Code |
40401600
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$433.87 |
| Max. Negotiated Rate |
$2,342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$808.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$433.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$433.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$433.87
|
| Rate for Payer: Brighton Health Commercial |
$2,342.00
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Cash Price |
$619.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$619.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,176.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,000.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$619.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$526.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$551.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$551.64
|
| Rate for Payer: Group Health Inc Commercial |
$619.82
|
| Rate for Payer: Group Health Inc Medicare |
$619.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$735.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$619.82
|
| Rate for Payer: Humana Medicare |
$632.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$619.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$495.86
|
| Rate for Payer: Wellcare Medicare |
$588.83
|
|
|
MS PUMP, 700 CX, 15X12MM
|
Facility
|
OP
|
$21,585.00
|
|
| Hospital Charge Code |
64906070
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7,554.75 |
| Max. Negotiated Rate |
$17,268.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,871.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10,792.50
|
| Rate for Payer: Aetna Government |
$10,792.50
|
| Rate for Payer: Brighton Health Commercial |
$16,188.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,268.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,677.80
|
| Rate for Payer: Group Health Inc Commercial |
$10,792.50
|
| Rate for Payer: Group Health Inc Medicare |
$7,554.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10,792.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10,792.50
|
|
|
MS PUMP, PRECON 700 18X12
|
Facility
|
OP
|
$21,992.50
|
|
| Hospital Charge Code |
64906061
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7,697.38 |
| Max. Negotiated Rate |
$17,594.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,095.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10,996.25
|
| Rate for Payer: Aetna Government |
$10,996.25
|
| Rate for Payer: Brighton Health Commercial |
$16,494.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,594.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,954.90
|
| Rate for Payer: Group Health Inc Commercial |
$10,996.25
|
| Rate for Payer: Group Health Inc Medicare |
$7,697.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10,996.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10,996.25
|
|
|
MTHFR
|
Facility
|
IP
|
$163.35
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
40629207
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$65.34
|
|
|
MTHFR
|
Facility
|
OP
|
$163.35
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
40629207
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.34
|
| Rate for Payer: Aetna Government |
$65.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$45.74
|
| Rate for Payer: Brighton Health Commercial |
$65.34
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$111.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$65.34
|
| Rate for Payer: EmblemHealth Commercial |
$65.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.15
|
| Rate for Payer: Group Health Inc Commercial |
$65.34
|
| Rate for Payer: Group Health Inc Medicare |
$65.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.34
|
| Rate for Payer: Healthfirst QHP |
$65.34
|
| Rate for Payer: Humana Medicare |
$66.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$52.27
|
| Rate for Payer: Wellcare Medicare |
$58.81
|
|
|
MTHFR, DNA MUTATION, NY
|
Facility
|
IP
|
$163.35
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
30305804
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$65.34
|
|
|
MTHFR, DNA MUTATION, NY
|
Facility
|
OP
|
$163.35
|
|
|
Service Code
|
HCPCS 81291
|
| Hospital Charge Code |
30305804
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$45.74 |
| Max. Negotiated Rate |
$130.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.34
|
| Rate for Payer: Aetna Government |
$65.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$45.74
|
| Rate for Payer: Brighton Health Commercial |
$65.34
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Cash Price |
$65.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$130.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$111.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$65.34
|
| Rate for Payer: EmblemHealth Commercial |
$65.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.15
|
| Rate for Payer: Group Health Inc Commercial |
$65.34
|
| Rate for Payer: Group Health Inc Medicare |
$65.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.34
|
| Rate for Payer: Healthfirst QHP |
$65.34
|
| Rate for Payer: Humana Medicare |
$66.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$52.27
|
| Rate for Payer: Wellcare Medicare |
$58.81
|
|
|
MTMS BY PHARM ADDL 15 MIN
|
Facility
|
OP
|
$82.65
|
|
|
Service Code
|
HCPCS 99607
|
| Hospital Charge Code |
30300352
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$26.28 |
| Max. Negotiated Rate |
$66.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.28
|
| Rate for Payer: Aetna Government |
$26.28
|
| Rate for Payer: Brighton Health Commercial |
$61.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.20
|
| Rate for Payer: Group Health Inc Commercial |
$41.32
|
| Rate for Payer: Group Health Inc Medicare |
$28.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.32
|
|
|
MTMS BY PHARM EST 15 MIN
|
Facility
|
OP
|
$82.65
|
|
|
Service Code
|
HCPCS 99606
|
| Hospital Charge Code |
30300351
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$66.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.06
|
| Rate for Payer: Aetna Government |
$28.06
|
| Rate for Payer: Brighton Health Commercial |
$61.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.20
|
| Rate for Payer: Group Health Inc Commercial |
$41.32
|
| Rate for Payer: Group Health Inc Medicare |
$28.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.32
|
|
|
MUCOLIPIDOSIS TYPE IV MUTATION
|
Facility
|
OP
|
$98.28
|
|
|
Service Code
|
HCPCS 81290
|
| Hospital Charge Code |
40603056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$78.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.31
|
| Rate for Payer: Aetna Government |
$39.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$27.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$27.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27.52
|
| Rate for Payer: Brighton Health Commercial |
$73.71
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Cash Price |
$39.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$39.31
|
| Rate for Payer: EmblemHealth Commercial |
$39.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$33.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$34.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$39.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.99
|
| Rate for Payer: Group Health Inc Commercial |
$39.31
|
| Rate for Payer: Group Health Inc Medicare |
$39.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.31
|
| Rate for Payer: Healthfirst QHP |
$39.31
|
| Rate for Payer: Humana Medicare |
$40.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$39.31
|
| Rate for Payer: United Healthcare Commercial |
$35.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.45
|
| Rate for Payer: Wellcare Medicare |
$35.38
|
|
|
MUCOLIPIDOSIS TYPE IV MUTATION
|
Facility
|
IP
|
$98.28
|
|
|
Service Code
|
HCPCS 81290
|
| Hospital Charge Code |
40603056
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$39.31
|
|
|
MUCOMYST/NEBULIZER BID
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306320
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
MUCOMYST/NEBULIZER BID
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306320
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
MUCOMYST/NEBULIZER Q6H
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40307420
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
MUCOMYST/NEBULIZER Q6H
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40307420
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
MUCOMYST/NEBULIZER Q8H
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306318
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
MUCOMYST/NEBULIZER Q8H
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306318
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
MUCOMYST/NEBULIZER QID
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306319
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
MUCOMYST/NEBULIZER QID
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306319
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
MUCUS SPECIMEN TRAP
|
Facility
|
OP
|
$9.57
|
|
| Hospital Charge Code |
40203918
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Brighton Health Commercial |
$7.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
MULE SLIP LUER ADAPTER
|
Facility
|
OP
|
$3.63
|
|
| Hospital Charge Code |
64905522
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.82
|
| Rate for Payer: Aetna Government |
$1.82
|
| Rate for Payer: Brighton Health Commercial |
$2.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.47
|
| Rate for Payer: Group Health Inc Commercial |
$1.82
|
| Rate for Payer: Group Health Inc Medicare |
$1.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.82
|
|
|
MULTI COMPRESS LWR LEG LFT
|
Facility
|
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29581 LT
|
| Hospital Charge Code |
42500168
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.55
|
| Rate for Payer: Brighton Health Commercial |
$303.81
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| 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 |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: Humana Medicare |
$185.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
|
MULTI COMPRESS LWR LEG LFT
|
Facility
|
IP
|
$405.08
|
|
|
Service Code
|
HCPCS 29581 LT
|
| Hospital Charge Code |
42500168
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$182.22
|
|
|
MULTI COMPRESS WRAP LWR LEG RT
|
Facility
|
IP
|
$405.08
|
|
|
Service Code
|
HCPCS 29581 RT
|
| Hospital Charge Code |
42500169
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$182.22
|
|
|
MULTI COMPRESS WRAP LWR LEG RT
|
Facility
|
OP
|
$405.08
|
|
|
Service Code
|
HCPCS 29581 RT
|
| Hospital Charge Code |
42500169
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$127.55 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$127.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$127.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$127.55
|
| Rate for Payer: Brighton Health Commercial |
$303.81
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| 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 |
$202.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: Humana Medicare |
$185.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
