|
MULTIDEX POWDER 12GM
|
Facility
|
OP
|
$55.34
|
|
| Hospital Charge Code |
41809548
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$44.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.67
|
| Rate for Payer: Aetna Government |
$27.67
|
| Rate for Payer: Brighton Health Commercial |
$41.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.63
|
| Rate for Payer: Group Health Inc Commercial |
$27.67
|
| Rate for Payer: Group Health Inc Medicare |
$19.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.67
|
|
|
MULTIDEX POWDER 12GM
|
Facility
|
OP
|
$55.34
|
|
| Hospital Charge Code |
41709548
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.37 |
| Max. Negotiated Rate |
$44.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.67
|
| Rate for Payer: Aetna Government |
$27.67
|
| Rate for Payer: Brighton Health Commercial |
$41.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.63
|
| Rate for Payer: Group Health Inc Commercial |
$27.67
|
| Rate for Payer: Group Health Inc Medicare |
$19.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.67
|
|
|
MULTI FAMILY GROUP THERAPY
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90849
|
| Hospital Charge Code |
30400089
|
|
Hospital Revenue Code
|
905
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
MULTI FAMILY GROUP THERAPY
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90849
|
| Hospital Charge Code |
30400089
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$6,747.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$218.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$151.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$151.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.47
|
| Rate for Payer: Amida Care Medicaid |
$67.47
|
| Rate for Payer: Brighton Health Commercial |
$298.39
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$68.09
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6,747.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.84
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.47
|
| Rate for Payer: Healthfirst Essential Plan |
$151.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$67.47
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$153.20
|
| Rate for Payer: Optum Commercial/Medicare |
$143.00
|
| Rate for Payer: Optum Medicaid |
$68.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.47
|
| Rate for Payer: SOMOS Essential |
$151.81
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$151.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$74.22
|
| Rate for Payer: United Healthcare Medicaid |
$67.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
MULTI-FAMILY GROUP THERAPY
|
Facility
|
OP
|
$397.85
|
|
|
Service Code
|
HCPCS 90849
|
| Hospital Charge Code |
30303125
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$6,747.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$184.38
|
| Rate for Payer: Aetna Government |
$184.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$151.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$151.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.47
|
| Rate for Payer: Amida Care Medicaid |
$67.47
|
| Rate for Payer: Brighton Health Commercial |
$298.39
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$68.09
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$184.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$318.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$184.38
|
| Rate for Payer: EmblemHealth Commercial |
$184.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6,747.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$67.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$67.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$184.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.84
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.47
|
| Rate for Payer: Healthfirst Essential Plan |
$151.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.72
|
| Rate for Payer: Healthfirst QHP |
$67.47
|
| Rate for Payer: Humana Medicare |
$188.07
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$68.09
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$153.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$153.20
|
| Rate for Payer: Optum Medicaid |
$68.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$184.38
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.47
|
| Rate for Payer: SOMOS Essential |
$151.81
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$151.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$74.22
|
| Rate for Payer: United Healthcare Medicaid |
$67.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$184.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Wellcare Medicare |
$175.16
|
|
|
MULTI-FAMILY GROUP THERAPY
|
Facility
|
IP
|
$397.85
|
|
|
Service Code
|
HCPCS 90849
|
| Hospital Charge Code |
30303125
|
|
Hospital Revenue Code
|
916
|
| Rate for Payer: Cash Price |
$184.38
|
|
|
MULTIFIRE 60 3.8 LOADING UNIT
|
Facility
|
OP
|
$130.09
|
|
| Hospital Charge Code |
64902599
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.53 |
| Max. Negotiated Rate |
$104.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.04
|
| Rate for Payer: Aetna Government |
$65.04
|
| Rate for Payer: Brighton Health Commercial |
$97.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.46
|
| Rate for Payer: Group Health Inc Commercial |
$65.04
|
| Rate for Payer: Group Health Inc Medicare |
$45.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.04
|
|
|
MULTIFIRE 60 3.8 LOADING UNIT
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
40200631
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$40.25 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57.50
|
| Rate for Payer: Aetna Government |
$57.50
|
| Rate for Payer: Brighton Health Commercial |
$86.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.20
|
| Rate for Payer: Group Health Inc Commercial |
$57.50
|
| Rate for Payer: Group Health Inc Medicare |
$40.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.50
|
|
|
MULTIFIRE SCORPION NEEDLE
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
64905518
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.50
|
| Rate for Payer: Aetna Government |
$42.50
|
| Rate for Payer: Brighton Health Commercial |
$63.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.80
|
| Rate for Payer: Group Health Inc Commercial |
$42.50
|
| Rate for Payer: Group Health Inc Medicare |
$29.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.50
|
|
|
MULTIFIRE VERSATACK
|
Facility
|
OP
|
$286.42
|
|
| Hospital Charge Code |
40200498
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$100.25 |
| Max. Negotiated Rate |
$229.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$157.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$143.21
|
| Rate for Payer: Aetna Government |
$143.21
|
| Rate for Payer: Brighton Health Commercial |
$214.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$229.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$194.77
|
| Rate for Payer: Group Health Inc Commercial |
$143.21
|
| Rate for Payer: Group Health Inc Medicare |
$100.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$143.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$143.21
|
|
|
MULTIPLE DOSE VIALS,#
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS 95165
|
| Hospital Charge Code |
30301420
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
MULTIPLE DOSE VIALS,#
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS 95165
|
| Hospital Charge Code |
30301420
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.45 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$38.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$38.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$38.45
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.89
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.89
|
| 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 |
$57.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.69
|
| Rate for Payer: Healthfirst QHP |
$54.93
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$54.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC
|
Facility
|
IP
|
$32,712.89
|
|
|
Service Code
|
MSDRG 059
|
| Min. Negotiated Rate |
$10,180.20 |
| Max. Negotiated Rate |
$32,712.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,505.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,791.19
|
| Rate for Payer: Aetna Government |
$23,791.19
|
| Rate for Payer: Brighton Health Commercial |
$17,214.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,267.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,501.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,918.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,601.63
|
| Rate for Payer: EmblemHealth Commercial |
$10,180.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,791.19
|
| Rate for Payer: Group Health Inc Commercial |
$23,791.19
|
| Rate for Payer: Group Health Inc Medicare |
$23,791.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,791.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,062.90
|
| Rate for Payer: Humana Medicare |
$32,712.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,791.19
|
| Rate for Payer: United Healthcare Commercial |
$23,609.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,791.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,791.19
|
| Rate for Payer: Wellcare Medicare |
$22,601.63
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC
|
Facility
|
IP
|
$43,022.77
|
|
|
Service Code
|
MSDRG 058
|
| Min. Negotiated Rate |
$14,549.52 |
| Max. Negotiated Rate |
$43,022.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25,477.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31,289.29
|
| Rate for Payer: Aetna Government |
$31,289.29
|
| Rate for Payer: Brighton Health Commercial |
$25,054.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31,915.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29,839.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24,624.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$29,724.83
|
| Rate for Payer: EmblemHealth Commercial |
$14,816.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$31,289.29
|
| Rate for Payer: Group Health Inc Commercial |
$31,289.29
|
| Rate for Payer: Group Health Inc Medicare |
$31,289.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31,289.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,549.52
|
| Rate for Payer: Humana Medicare |
$43,022.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31,289.29
|
| Rate for Payer: United Healthcare Commercial |
$34,362.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,289.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31,289.29
|
| Rate for Payer: Wellcare Medicare |
$29,724.83
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC
|
Facility
|
IP
|
$27,187.08
|
|
|
Service Code
|
MSDRG 060
|
| Min. Negotiated Rate |
$7,695.21 |
| Max. Negotiated Rate |
$27,187.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,232.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,772.42
|
| Rate for Payer: Aetna Government |
$19,772.42
|
| Rate for Payer: Brighton Health Commercial |
$13,012.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,167.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,497.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,788.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,783.80
|
| Rate for Payer: EmblemHealth Commercial |
$7,695.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,772.42
|
| Rate for Payer: Group Health Inc Commercial |
$19,772.42
|
| Rate for Payer: Group Health Inc Medicare |
$19,772.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,772.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,194.18
|
| Rate for Payer: Humana Medicare |
$27,187.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,772.42
|
| Rate for Payer: United Healthcare Commercial |
$17,846.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,772.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,772.42
|
| Rate for Payer: Wellcare Medicare |
$18,783.80
|
|
|
MULTIPLE VITAMINS-LIVER CAPSULE
|
Facility
|
OP
|
$0.34
|
|
| Hospital Charge Code |
41644097
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna Government |
$0.17
|
| Rate for Payer: Brighton Health Commercial |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.23
|
| Rate for Payer: Group Health Inc Commercial |
$0.17
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.22
|
|
|
MULTIPLE VITAMINS-LIVER CAPSULE
|
Facility
|
OP
|
$0.34
|
|
| Hospital Charge Code |
41654097
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna Government |
$0.17
|
| Rate for Payer: Brighton Health Commercial |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.23
|
| Rate for Payer: Group Health Inc Commercial |
$0.17
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.22
|
|
|
MULTIPOL BI CUP SHELL 51 MM O.D
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$132.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$110.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$126.50
|
| Rate for Payer: EmblemHealth Commercial |
$110.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.00
|
| Rate for Payer: Group Health Inc Commercial |
$110.00
|
| Rate for Payer: Group Health Inc Medicare |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.00
|
|
|
MULTIPOL BI CUP SHELL 51 MM O.D
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204216
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$110.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
|
|
MULTIVITAMINS (ADULT) INJ
|
Facility
|
OP
|
$9.78
|
|
| Hospital Charge Code |
41644702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.89
|
| Rate for Payer: Aetna Government |
$4.89
|
| Rate for Payer: Brighton Health Commercial |
$7.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.65
|
| Rate for Payer: Group Health Inc Commercial |
$4.89
|
| Rate for Payer: Group Health Inc Medicare |
$3.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.36
|
|
|
MULTIVITAMINS (ADULT) INJ
|
Facility
|
OP
|
$9.78
|
|
| Hospital Charge Code |
41654702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.89
|
| Rate for Payer: Aetna Government |
$4.89
|
| Rate for Payer: Brighton Health Commercial |
$7.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.65
|
| Rate for Payer: Group Health Inc Commercial |
$4.89
|
| Rate for Payer: Group Health Inc Medicare |
$3.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.36
|
|
|
MULTIVITAMINS DROPS LIQUID PEDIATRIC
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
41652305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
MULTIVITAMINS DROPS LIQUID PEDIATRIC
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
41642305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Brighton Health Commercial |
$6.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
MULTIVITAMINS INJ PEDIATRIC
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
41642844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.50
|
| Rate for Payer: Aetna Government |
$6.50
|
| Rate for Payer: Brighton Health Commercial |
$9.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.84
|
| Rate for Payer: Group Health Inc Commercial |
$6.50
|
| Rate for Payer: Group Health Inc Medicare |
$4.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.45
|
|
|
MULTIVITAMINS INJ PEDIATRIC
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
41652844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.50
|
| Rate for Payer: Aetna Government |
$6.50
|
| Rate for Payer: Brighton Health Commercial |
$9.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.84
|
| Rate for Payer: Group Health Inc Commercial |
$6.50
|
| Rate for Payer: Group Health Inc Medicare |
$4.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.45
|
|
