|
NEEDLE SPINAL 25G X 3 1/2
|
Facility
|
OP
|
$20.50
|
|
| Hospital Charge Code |
64902299
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$16.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.25
|
| Rate for Payer: Aetna Government |
$10.25
|
| Rate for Payer: Brighton Health Commercial |
$15.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.94
|
| Rate for Payer: Group Health Inc Commercial |
$10.25
|
| Rate for Payer: Group Health Inc Medicare |
$7.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.25
|
|
|
NEEDLE SPINAL 25G X 5 BRAUN
|
Facility
|
OP
|
$12.52
|
|
| Hospital Charge Code |
64904165
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$10.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Government |
$6.26
|
| Rate for Payer: Brighton Health Commercial |
$9.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.51
|
| Rate for Payer: Group Health Inc Commercial |
$6.26
|
| Rate for Payer: Group Health Inc Medicare |
$4.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.26
|
|
|
NEEDLE SPINAL 25GX5 BRAUN
|
Facility
|
OP
|
$77.00
|
|
| Hospital Charge Code |
40200972
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$61.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.50
|
| Rate for Payer: Aetna Government |
$38.50
|
| Rate for Payer: Brighton Health Commercial |
$57.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$61.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$52.36
|
| Rate for Payer: Group Health Inc Commercial |
$38.50
|
| Rate for Payer: Group Health Inc Medicare |
$26.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.50
|
|
|
NEEDLE SPINAL QUINCKE 25GX3.5
|
Facility
|
OP
|
$118.20
|
|
| Hospital Charge Code |
64905825
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$41.37 |
| Max. Negotiated Rate |
$94.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$65.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.10
|
| Rate for Payer: Aetna Government |
$59.10
|
| Rate for Payer: Brighton Health Commercial |
$88.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$94.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$80.38
|
| Rate for Payer: Group Health Inc Commercial |
$59.10
|
| Rate for Payer: Group Health Inc Medicare |
$41.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$59.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$59.10
|
|
|
NEEDLE SPINAL QUINCKE 25X5
|
Facility
|
OP
|
$252.50
|
|
| Hospital Charge Code |
64905822
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.38 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$126.25
|
| Rate for Payer: Aetna Government |
$126.25
|
| Rate for Payer: Brighton Health Commercial |
$189.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$202.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$171.70
|
| Rate for Payer: Group Health Inc Commercial |
$126.25
|
| Rate for Payer: Group Health Inc Medicare |
$88.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.25
|
|
|
NEEDLE TROCAR TIP, PAK
|
Facility
|
OP
|
$500.00
|
|
| Hospital Charge Code |
64906184
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$250.00
|
| Rate for Payer: Aetna Government |
$250.00
|
| Rate for Payer: Brighton Health Commercial |
$375.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$340.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
|
|
NEEDLE VERESS 120MM
|
Facility
|
OP
|
$21.68
|
|
| Hospital Charge Code |
40200499
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$17.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.84
|
| Rate for Payer: Aetna Government |
$10.84
|
| Rate for Payer: Brighton Health Commercial |
$16.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.74
|
| Rate for Payer: Group Health Inc Commercial |
$10.84
|
| Rate for Payer: Group Health Inc Medicare |
$7.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.84
|
|
|
NEGATIVE PRESS WOUND TX<50 SQ CM
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
42500189
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
NEGATIVE PRESS WOUND TX<50 SQ CM
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97605
|
| Hospital Charge Code |
42500189
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$396.92
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
NEGATIVE PRESS WOUND TX>50 SQ CM
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
42500190
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
NEGATIVE PRESS WOUND TX>50 SQ CM
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 97606
|
| Hospital Charge Code |
42500190
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$532.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$532.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
NEG PRESS WOUND THERAPY <=50 SQCM
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
42501000
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$532.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$725.80
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| Rate for Payer: Group Health Inc Commercial |
$461.12
|
| Rate for Payer: Group Health Inc Medicare |
$461.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
NEG PRESS WOUND THERAPY <=50 SQCM
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 97607
|
| Hospital Charge Code |
42501000
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
NEG PRESS WOUND THERAPY > 50 SQCM
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 97608
|
| Hospital Charge Code |
42501001
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
NEG PRESS WOUND THERAPY > 50 SQCM
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 97608
|
| Hospital Charge Code |
42501001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$532.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$725.80
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| Rate for Payer: Group Health Inc Commercial |
$461.12
|
| Rate for Payer: Group Health Inc Medicare |
$461.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
NELFINAVIR 250 MG TAB
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
41643259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
NELFINAVIR 250 MG TAB
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
41653259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
NELFINAVIR 625 MG TAB
|
Facility
|
OP
|
$12.64
|
|
| Hospital Charge Code |
41653542
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.32
|
| Rate for Payer: Aetna Government |
$6.32
|
| Rate for Payer: Brighton Health Commercial |
$9.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.60
|
| Rate for Payer: Group Health Inc Commercial |
$6.32
|
| Rate for Payer: Group Health Inc Medicare |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.22
|
|
|
NELFINAVIR 625 MG TAB
|
Facility
|
OP
|
$12.64
|
|
| Hospital Charge Code |
41643542
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.32
|
| Rate for Payer: Aetna Government |
$6.32
|
| Rate for Payer: Brighton Health Commercial |
$9.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.60
|
| Rate for Payer: Group Health Inc Commercial |
$6.32
|
| Rate for Payer: Group Health Inc Medicare |
$4.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.22
|
|
|
NELFINAVIR MESYLATE 250 MG PO TABS [20032]
|
Facility
|
OP
|
$4.86
|
|
|
Service Code
|
NDC 63010001030
|
| Hospital Charge Code |
63010001030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.43
|
| Rate for Payer: Aetna Government |
$2.43
|
| Rate for Payer: Brighton Health Commercial |
$3.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.30
|
| Rate for Payer: Group Health Inc Commercial |
$2.43
|
| Rate for Payer: Group Health Inc Medicare |
$1.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.16
|
|
|
NELFINAVIR MESYLATE 625 MG PO TABS [38318]
|
Facility
|
OP
|
$12.14
|
|
|
Service Code
|
NDC 63010002770
|
| Hospital Charge Code |
63010002770
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.07
|
| Rate for Payer: Aetna Government |
$6.07
|
| Rate for Payer: Brighton Health Commercial |
$9.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.26
|
| Rate for Payer: Group Health Inc Commercial |
$6.07
|
| Rate for Payer: Group Health Inc Medicare |
$4.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.89
|
|
|
NELLCOR ADULT SP02 SENSOR
|
Facility
|
OP
|
$17.40
|
|
| Hospital Charge Code |
66526865
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$13.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.70
|
| Rate for Payer: Aetna Government |
$8.70
|
| Rate for Payer: Brighton Health Commercial |
$13.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.83
|
| Rate for Payer: Group Health Inc Commercial |
$8.70
|
| Rate for Payer: Group Health Inc Medicare |
$6.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.70
|
|
|
NEOGUARD THERMAL REFLECTORS
|
Facility
|
OP
|
$1.10
|
|
| Hospital Charge Code |
64903696
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.75
|
| Rate for Payer: Group Health Inc Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Medicare |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.55
|
|
|
NEOGUARD THERMAL REFLECTORS, SM
|
Facility
|
OP
|
$0.98
|
|
| Hospital Charge Code |
64903698
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.49
|
| Rate for Payer: Aetna Government |
$0.49
|
| Rate for Payer: Brighton Health Commercial |
$0.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.67
|
| Rate for Payer: Group Health Inc Commercial |
$0.49
|
| Rate for Payer: Group Health Inc Medicare |
$0.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.49
|
|
|
NEOMYCIN 500 MG TAB
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
41650601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
