|
NORTRIPTYLINE 10 MG CAP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640769
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
NORTRIPTYLINE 10 MG CAP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650769
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
NORTRIPTYLINE 25 MG CAP
|
Facility
|
OP
|
$0.27
|
|
| Hospital Charge Code |
41654023
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.18
|
|
|
NORTRIPTYLINE 25 MG CAP
|
Facility
|
OP
|
$0.27
|
|
| Hospital Charge Code |
41644023
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.14
|
| Rate for Payer: Aetna Government |
$0.14
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.18
|
|
|
NORTRIPTYLINE 50 MG CAP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41645269
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
NORTRIPTYLINE 50 MG CAP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41655269
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
NORTRIPTYLINE (AVENTYL) SERUM
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 80335
|
| Hospital Charge Code |
40609715
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$33.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.60
|
| Rate for Payer: Group Health Inc Commercial |
$22.50
|
| Rate for Payer: Group Health Inc Medicare |
$15.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
| Rate for Payer: United Healthcare Commercial |
$21.92
|
|
|
NORTRIPTYLINE HCL 10 MG PO CAPS [5674]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
NDC 51672400101
|
| Hospital Charge Code |
51672400101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.37
|
| Rate for Payer: Aetna Government |
$0.37
|
| Rate for Payer: Brighton Health Commercial |
$0.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.50
|
| Rate for Payer: Group Health Inc Commercial |
$0.37
|
| Rate for Payer: Group Health Inc Medicare |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.48
|
|
|
NORTRIPTYLINE HCL 10 MG PO CAPS [5674]
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 60687028111
|
| Hospital Charge Code |
60687028111
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$0.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.30
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.29
|
|
|
NORTRIPTYLINE HCL 25 MG PO CAPS [5675]
|
Facility
|
OP
|
$1.47
|
|
|
Service Code
|
NDC 51672400201
|
| Hospital Charge Code |
51672400201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.73
|
| Rate for Payer: Aetna Government |
$0.73
|
| Rate for Payer: Brighton Health Commercial |
$1.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.00
|
| Rate for Payer: Group Health Inc Commercial |
$0.73
|
| Rate for Payer: Group Health Inc Medicare |
$0.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.95
|
|
|
NORTRIPTYLINE HCL 25 MG PO CAPS [5675]
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 60687029311
|
| Hospital Charge Code |
60687029311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.44
|
| Rate for Payer: Aetna Government |
$0.44
|
| Rate for Payer: Brighton Health Commercial |
$0.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.44
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.57
|
|
|
NORTRIPTYLINE HCL 50 MG PO CAPS [5676]
|
Facility
|
OP
|
$2.77
|
|
|
Service Code
|
NDC 51672400301
|
| Hospital Charge Code |
51672400301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.52
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.38
|
| Rate for Payer: Aetna Government |
$1.38
|
| Rate for Payer: Brighton Health Commercial |
$2.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.88
|
| Rate for Payer: Group Health Inc Commercial |
$1.38
|
| Rate for Payer: Group Health Inc Medicare |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.80
|
|
|
NO TRTMT CHEMO AND HER2
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2208
|
| Hospital Charge Code |
30300336
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
NOT SCRN ETOH NO RSN
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2199
|
| Hospital Charge Code |
30300327
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
NRPSYC TST EVAL PHYS/QHP 1ST
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 96132
|
| Hospital Charge Code |
30307925
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$96.74 |
| Max. Negotiated Rate |
$9,674.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Government |
$619.82
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$217.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$217.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$96.74
|
| Rate for Payer: Amida Care Medicaid |
$96.74
|
| Rate for Payer: Brighton Health Commercial |
$314.27
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$97.62
|
| 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 |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Elderplan Medicare Advantage |
$619.82
|
| Rate for Payer: EmblemHealth Commercial |
$619.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9,674.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$96.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$619.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$101.58
|
| 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 |
$96.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$619.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.74
|
| Rate for Payer: Healthfirst Essential Plan |
$217.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$526.85
|
| Rate for Payer: Healthfirst QHP |
$96.74
|
| Rate for Payer: Humana Medicare |
$632.22
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$97.62
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$219.64
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$219.64
|
| Rate for Payer: Optum Medicaid |
$97.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$619.82
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$96.74
|
| Rate for Payer: SOMOS Essential |
$217.66
|
| Rate for Payer: United Healthcare Commercial |
$209.52
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$217.66
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$106.41
|
| Rate for Payer: United Healthcare Medicaid |
$96.74
|
| 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
|
|
|
NRPSYC TST EVAL PHYS/QHP 1ST
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 96132
|
| Hospital Charge Code |
30307925
|
|
Hospital Revenue Code
|
918
|
| Rate for Payer: Cash Price |
$619.82
|
|
|
NRPSYC TST EVAL PHYS/QHP EA
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 96133
|
| Hospital Charge Code |
30307926
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$69.27 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.27
|
| Rate for Payer: Aetna Government |
$69.27
|
| Rate for Payer: Brighton Health Commercial |
$314.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Group Health Inc Commercial |
$209.52
|
| Rate for Payer: Group Health Inc Medicare |
$146.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.52
|
| Rate for Payer: United Healthcare Commercial |
$209.52
|
|
|
N-TELOPEPTIDE SERUM
|
Facility
|
OP
|
$46.70
|
|
|
Service Code
|
HCPCS 82523
|
| Hospital Charge Code |
40609747
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$35.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.68
|
| Rate for Payer: Aetna Government |
$18.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.08
|
| Rate for Payer: Brighton Health Commercial |
$35.02
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.68
|
| Rate for Payer: EmblemHealth Commercial |
$18.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.63
|
| Rate for Payer: Group Health Inc Commercial |
$18.68
|
| Rate for Payer: Group Health Inc Medicare |
$18.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.68
|
| Rate for Payer: Healthfirst QHP |
$18.68
|
| Rate for Payer: Humana Medicare |
$19.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.68
|
| Rate for Payer: United Healthcare Commercial |
$23.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.94
|
| Rate for Payer: Wellcare Medicare |
$16.81
|
|
|
N-TELOPEPTIDE SERUM
|
Facility
|
IP
|
$46.70
|
|
|
Service Code
|
HCPCS 82523
|
| Hospital Charge Code |
40609747
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$18.68
|
|
|
NUFIX CORT ANTIMIGRATIONDOWEL 5MM
|
Facility
|
OP
|
$4,250.00
|
|
| Hospital Charge Code |
40202233
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,487.50 |
| Max. Negotiated Rate |
$3,400.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,337.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,125.00
|
| Rate for Payer: Aetna Government |
$2,125.00
|
| Rate for Payer: Brighton Health Commercial |
$3,187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,400.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,890.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,125.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,487.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,125.00
|
|
|
NU-GAUZE PACKING - 1
|
Facility
|
OP
|
$4.25
|
|
| Hospital Charge Code |
40000275
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.12
|
| Rate for Payer: Aetna Government |
$2.12
|
| Rate for Payer: Brighton Health Commercial |
$3.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.89
|
| Rate for Payer: Group Health Inc Commercial |
$2.12
|
| Rate for Payer: Group Health Inc Medicare |
$1.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.12
|
|
|
NU-GAUZE PACKING 1/2
|
Facility
|
OP
|
$4.25
|
|
| Hospital Charge Code |
40000270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.12
|
| Rate for Payer: Aetna Government |
$2.12
|
| Rate for Payer: Brighton Health Commercial |
$3.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.89
|
| Rate for Payer: Group Health Inc Commercial |
$2.12
|
| Rate for Payer: Group Health Inc Medicare |
$1.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.12
|
|
|
NU-GAUZE PACKING - 2
|
Facility
|
OP
|
$4.97
|
|
| Hospital Charge Code |
40000280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.48
|
| Rate for Payer: Aetna Government |
$2.48
|
| Rate for Payer: Brighton Health Commercial |
$3.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$2.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.48
|
|
|
Nu-gel
|
Facility
|
OP
|
$21.62
|
|
| Hospital Charge Code |
40204400
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$17.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.81
|
| Rate for Payer: Aetna Government |
$10.81
|
| Rate for Payer: Brighton Health Commercial |
$16.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.70
|
| Rate for Payer: Group Health Inc Commercial |
$10.81
|
| Rate for Payer: Group Health Inc Medicare |
$7.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.81
|
|
|
NURSING INCREMENTAL
|
Facility
|
OP
|
$4,158.00
|
|
| Hospital Charge Code |
30000150
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$1,455.30 |
| Max. Negotiated Rate |
$3,326.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,286.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,079.00
|
| Rate for Payer: Aetna Government |
$2,079.00
|
| Rate for Payer: Brighton Health Commercial |
$3,118.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,326.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,827.44
|
| Rate for Payer: Group Health Inc Commercial |
$2,079.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,455.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,079.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,079.00
|
|
