|
MYOMECTOMY - VAGINAL APPROACH
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58145
|
| Hospital Charge Code |
40059988
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
MYOMECTOMY VAG METHOD
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58145
|
| Hospital Charge Code |
40059952
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
MYOMECTOMY VAG METHOD
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 58145
|
| Hospital Charge Code |
40059952
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$5,674.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Brighton Health Commercial |
$5,674.60
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
MYOTOMY
|
Facility
|
OP
|
$5,670.00
|
|
|
Service Code
|
HCPCS D7856
|
| Hospital Charge Code |
42301975
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,305.33 |
| Max. Negotiated Rate |
$4,252.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,118.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,305.33
|
| Rate for Payer: Aetna Government |
$1,305.33
|
| Rate for Payer: Brighton Health Commercial |
$4,252.50
|
| 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: Group Health Inc Commercial |
$2,835.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,984.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,835.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,835.00
|
|
|
MYRINGOTOMY
|
Facility
|
OP
|
$616.78
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
40108880
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.73 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$197.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$197.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$197.73
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$282.47
|
| 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: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| 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 |
$308.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.10
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: Humana Medicare |
$288.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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
|
|
|
MYRINGOTOMY
|
Facility
|
IP
|
$616.78
|
|
|
Service Code
|
HCPCS 69420
|
| Hospital Charge Code |
40108880
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$282.47
|
|
|
MYRINGOTOMY UNDER GENERAL ANESTHE
|
Facility
|
IP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 69421
|
| Hospital Charge Code |
40109211
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,723.23
|
|
|
MYRINGOTOMY UNDER GENERAL ANESTHE
|
Facility
|
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 69421
|
| Hospital Charge Code |
40109211
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$5,949.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,606.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,606.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,606.26
|
| Rate for Payer: Brighton Health Commercial |
$5,949.88
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| 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 |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: Humana Medicare |
$3,797.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
N-ACETYLPROCAINAMID
|
Facility
|
IP
|
$41.88
|
|
|
Service Code
|
HCPCS 80192
|
| Hospital Charge Code |
40602035
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$16.75
|
|
|
N-ACETYLPROCAINAMID
|
Facility
|
OP
|
$41.88
|
|
|
Service Code
|
HCPCS 80192
|
| Hospital Charge Code |
40602035
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$31.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.75
|
| Rate for Payer: Aetna Government |
$16.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.72
|
| Rate for Payer: Brighton Health Commercial |
$31.41
|
| Rate for Payer: Cash Price |
$16.75
|
| Rate for Payer: Cash Price |
$16.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.75
|
| Rate for Payer: EmblemHealth Commercial |
$16.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.91
|
| Rate for Payer: Group Health Inc Commercial |
$16.75
|
| Rate for Payer: Group Health Inc Medicare |
$16.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.75
|
| Rate for Payer: Healthfirst QHP |
$16.75
|
| Rate for Payer: Humana Medicare |
$17.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.75
|
| Rate for Payer: United Healthcare Commercial |
$21.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.40
|
| Rate for Payer: Wellcare Medicare |
$15.08
|
|
|
NAFCILLIN 1G VIAL
|
Facility
|
OP
|
$13.25
|
|
| Hospital Charge Code |
41658179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$10.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.62
|
| Rate for Payer: Aetna Government |
$6.62
|
| Rate for Payer: Brighton Health Commercial |
$9.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.01
|
| Rate for Payer: Group Health Inc Commercial |
$6.62
|
| Rate for Payer: Group Health Inc Medicare |
$4.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.61
|
|
|
NAFCILLIN 1G VIAL
|
Facility
|
OP
|
$13.25
|
|
| Hospital Charge Code |
41648179
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$10.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.62
|
| Rate for Payer: Aetna Government |
$6.62
|
| Rate for Payer: Brighton Health Commercial |
$9.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.01
|
| Rate for Payer: Group Health Inc Commercial |
$6.62
|
| Rate for Payer: Group Health Inc Medicare |
$4.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.61
|
|
|
NAFCILLIN 2G VIAL
|
Facility
|
OP
|
$26.28
|
|
| Hospital Charge Code |
41648181
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$21.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.14
|
| Rate for Payer: Aetna Government |
$13.14
|
| Rate for Payer: Brighton Health Commercial |
$19.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.87
|
| Rate for Payer: Group Health Inc Commercial |
$13.14
|
| Rate for Payer: Group Health Inc Medicare |
$9.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.08
|
|
|
NAFCILLIN 2G VIAL
|
Facility
|
OP
|
$26.28
|
|
| Hospital Charge Code |
41658181
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$21.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.14
|
| Rate for Payer: Aetna Government |
$13.14
|
| Rate for Payer: Brighton Health Commercial |
$19.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.87
|
| Rate for Payer: Group Health Inc Commercial |
$13.14
|
| Rate for Payer: Group Health Inc Medicare |
$9.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.08
|
|
|
NAFCILLIN SODIUM 1 G IJ SOLR [5333]
|
Facility
|
OP
|
$14.50
|
|
|
Service Code
|
NDC 55150012215
|
| Hospital Charge Code |
55150012215
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$11.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.25
|
| Rate for Payer: Aetna Government |
$7.25
|
| Rate for Payer: Brighton Health Commercial |
$10.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.86
|
| Rate for Payer: Group Health Inc Commercial |
$7.25
|
| Rate for Payer: Group Health Inc Medicare |
$5.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.42
|
|
|
NAFCILLIN SODIUM 1 G IJ SOLR [5333]
|
Facility
|
OP
|
$13.70
|
|
|
Service Code
|
NDC 67850003100
|
| Hospital Charge Code |
67850003100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.85
|
| Rate for Payer: Aetna Government |
$6.85
|
| Rate for Payer: Brighton Health Commercial |
$10.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.32
|
| Rate for Payer: Group Health Inc Commercial |
$6.85
|
| Rate for Payer: Group Health Inc Medicare |
$4.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.90
|
|
|
NAFCILLIN SODIUM 1 G IJ SOLR [5333]
|
Facility
|
OP
|
$13.70
|
|
|
Service Code
|
NDC 67850003110
|
| Hospital Charge Code |
67850003110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$10.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.85
|
| Rate for Payer: Aetna Government |
$6.85
|
| Rate for Payer: Brighton Health Commercial |
$10.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.32
|
| Rate for Payer: Group Health Inc Commercial |
$6.85
|
| Rate for Payer: Group Health Inc Medicare |
$4.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.90
|
|
|
NAFCILLIN SODIUM 1 G IJ SOLR [5333]
|
Facility
|
OP
|
$17.87
|
|
|
Service Code
|
NDC 63323032710
|
| Hospital Charge Code |
63323032710
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$14.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.93
|
| Rate for Payer: Aetna Government |
$8.93
|
| Rate for Payer: Brighton Health Commercial |
$13.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.15
|
| Rate for Payer: Group Health Inc Commercial |
$8.93
|
| Rate for Payer: Group Health Inc Medicare |
$6.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.61
|
|
|
NAFCILLIN SODIUM 2 G IJ SOLR [5335]
|
Facility
|
OP
|
$34.67
|
|
|
Service Code
|
NDC 63323032820
|
| Hospital Charge Code |
63323032820
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.13 |
| Max. Negotiated Rate |
$27.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.33
|
| Rate for Payer: Aetna Government |
$17.33
|
| Rate for Payer: Brighton Health Commercial |
$26.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.57
|
| Rate for Payer: Group Health Inc Commercial |
$17.33
|
| Rate for Payer: Group Health Inc Medicare |
$12.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.53
|
|
|
NAFCILLIN SODIUM 2 G IJ SOLR [5335]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 55150012315
|
| Hospital Charge Code |
55150012315
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.50
|
| Rate for Payer: Aetna Government |
$7.50
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.20
|
| Rate for Payer: Group Health Inc Commercial |
$7.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.75
|
|
|
NAIL
|
Facility
|
OP
|
$5,308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$5,573.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,919.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$3,184.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,654.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,052.10
|
| Rate for Payer: EmblemHealth Commercial |
$2,654.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,573.40
|
| Rate for Payer: Group Health Inc Commercial |
$2,654.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,857.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,654.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,654.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,450.20
|
|
|
NAIL
|
Facility
|
IP
|
$5,308.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203569
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,654.00 |
| Max. Negotiated Rate |
$2,654.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,654.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,654.00
|
|
|
NAIL 11 X 340 130
|
Facility
|
OP
|
$8,372.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$8,791.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,604.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$5,023.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,186.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,814.19
|
| Rate for Payer: EmblemHealth Commercial |
$4,186.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,791.12
|
| Rate for Payer: Group Health Inc Commercial |
$4,186.25
|
| Rate for Payer: Group Health Inc Medicare |
$2,930.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,186.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,186.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,442.12
|
|
|
NAIL 11 X 340 130
|
Facility
|
IP
|
$8,372.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904411
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,186.25 |
| Max. Negotiated Rate |
$4,186.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,186.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,186.25
|
|
|
NAIL 11 X 440 L
|
Facility
|
OP
|
$4,754.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903510
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,992.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,615.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$2,852.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,377.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,733.98
|
| Rate for Payer: EmblemHealth Commercial |
$2,377.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,992.49
|
| Rate for Payer: Group Health Inc Commercial |
$2,377.38
|
| Rate for Payer: Group Health Inc Medicare |
$1,664.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,377.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,377.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,090.59
|
|
