|
POCT RAPID COVID 19 ANTIGEN
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS 87811 QW
|
| Hospital Charge Code |
40604131
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$41.38
|
|
|
POCT RAPID STREP A TEST
|
Facility
|
OP
|
$41.33
|
|
|
Service Code
|
HCPCS 87880 QW
|
| Hospital Charge Code |
40614169
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.53
|
| Rate for Payer: Aetna Government |
$16.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.57
|
| Rate for Payer: Brighton Health Commercial |
$31.00
|
| Rate for Payer: Cash Price |
$16.53
|
| Rate for Payer: Cash Price |
$16.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.53
|
| Rate for Payer: EmblemHealth Commercial |
$16.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.71
|
| Rate for Payer: Group Health Inc Commercial |
$16.53
|
| Rate for Payer: Group Health Inc Medicare |
$16.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.53
|
| Rate for Payer: Healthfirst QHP |
$16.53
|
| Rate for Payer: Humana Medicare |
$16.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.53
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.22
|
| Rate for Payer: Wellcare Medicare |
$14.88
|
|
|
POCT RAPID STREP A TEST
|
Facility
|
IP
|
$41.33
|
|
|
Service Code
|
HCPCS 87880 QW
|
| Hospital Charge Code |
40614169
|
|
Hospital Revenue Code
|
306
|
| Rate for Payer: Cash Price |
$16.53
|
|
|
POCT SARS-COV-2/FLLU/RSV XPERT XP
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
HCPCS 0241U QW
|
| Hospital Charge Code |
40604133
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$142.63
|
|
|
POCT SARS-COV-2/FLLU/RSV XPERT XP
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
HCPCS 0241U QW
|
| Hospital Charge Code |
40604133
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$145.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$93.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$142.63
|
| Rate for Payer: Aetna Government |
$142.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$99.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$99.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$99.84
|
| Rate for Payer: Brighton Health Commercial |
$142.63
|
| Rate for Payer: Cash Price |
$142.63
|
| Rate for Payer: Cash Price |
$142.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$142.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$115.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$142.63
|
| Rate for Payer: EmblemHealth Commercial |
$142.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$121.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$126.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$142.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$126.94
|
| Rate for Payer: Group Health Inc Commercial |
$142.63
|
| Rate for Payer: Group Health Inc Medicare |
$142.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$121.24
|
| Rate for Payer: Healthfirst QHP |
$142.63
|
| Rate for Payer: Humana Medicare |
$145.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$142.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$142.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$114.10
|
| Rate for Payer: Wellcare Medicare |
$128.37
|
|
|
POCT SARS-COV-2 XPERT XPRESS CEPH
|
Facility
|
OP
|
$96.25
|
|
|
Service Code
|
HCPCS 87635 QW
|
| Hospital Charge Code |
40604132
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.92 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.31
|
| Rate for Payer: Aetna Government |
$51.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$35.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$35.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$35.92
|
| Rate for Payer: Brighton Health Commercial |
$72.19
|
| Rate for Payer: Cash Price |
$51.31
|
| Rate for Payer: Cash Price |
$51.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$77.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$65.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$51.31
|
| Rate for Payer: EmblemHealth Commercial |
$51.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.67
|
| Rate for Payer: Group Health Inc Commercial |
$51.31
|
| Rate for Payer: Group Health Inc Medicare |
$51.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.31
|
| Rate for Payer: Healthfirst QHP |
$51.31
|
| Rate for Payer: Humana Medicare |
$52.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.31
|
| Rate for Payer: United Healthcare Commercial |
$46.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41.05
|
| Rate for Payer: Wellcare Medicare |
$46.18
|
|
|
POCT SARS-COV-2 XPERT XPRESS CEPH
|
Facility
|
IP
|
$96.25
|
|
|
Service Code
|
HCPCS 87635 QW
|
| Hospital Charge Code |
40604132
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$51.31
|
|
|
POCT URINALYSIS
|
Facility
|
OP
|
$5.63
|
|
|
Service Code
|
HCPCS 81003 QW
|
| Hospital Charge Code |
40626014
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.25
|
| Rate for Payer: Aetna Government |
$2.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1.58
|
| Rate for Payer: Brighton Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$2.25
|
| Rate for Payer: EmblemHealth Commercial |
$2.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2.00
|
| Rate for Payer: Group Health Inc Commercial |
$2.25
|
| Rate for Payer: Group Health Inc Medicare |
$2.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2.25
|
| Rate for Payer: Healthfirst QHP |
$2.25
|
| Rate for Payer: Humana Medicare |
$2.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.80
|
| Rate for Payer: Wellcare Medicare |
$2.02
|
|
|
POCT URINALYSIS
|
Facility
|
IP
|
$5.63
|
|
|
Service Code
|
HCPCS 81003 QW
|
| Hospital Charge Code |
40626014
|
|
Hospital Revenue Code
|
310
|
| Rate for Payer: Cash Price |
$2.25
|
|
|
POCT VENOUS BLOOD OXIMETERY
|
Facility
|
IP
|
$24.43
|
|
|
Service Code
|
HCPCS 82810
|
| Hospital Charge Code |
40602791
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$9.77
|
|
|
POCT VENOUS BLOOD OXIMETERY
|
Facility
|
OP
|
$24.43
|
|
|
Service Code
|
HCPCS 82810
|
| Hospital Charge Code |
40602791
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$18.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.77
|
| Rate for Payer: Aetna Government |
$9.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.84
|
| Rate for Payer: Brighton Health Commercial |
$18.32
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.77
|
| Rate for Payer: EmblemHealth Commercial |
$9.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.70
|
| Rate for Payer: Group Health Inc Commercial |
$9.77
|
| Rate for Payer: Group Health Inc Medicare |
$9.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.77
|
| Rate for Payer: Healthfirst QHP |
$9.77
|
| Rate for Payer: Humana Medicare |
$9.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.77
|
| Rate for Payer: United Healthcare Commercial |
$11.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.82
|
| Rate for Payer: Wellcare Medicare |
$8.79
|
|
|
PODOPHYLLUM 25% SOLUTION
|
Facility
|
OP
|
$200.08
|
|
| Hospital Charge Code |
41651114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.03 |
| Max. Negotiated Rate |
$160.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.04
|
| Rate for Payer: Aetna Government |
$100.04
|
| Rate for Payer: Brighton Health Commercial |
$150.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.05
|
| Rate for Payer: Group Health Inc Commercial |
$100.04
|
| Rate for Payer: Group Health Inc Medicare |
$70.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.05
|
|
|
PODOPHYLLUM 25% SOLUTION
|
Facility
|
OP
|
$200.08
|
|
| Hospital Charge Code |
41641114
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.03 |
| Max. Negotiated Rate |
$160.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.04
|
| Rate for Payer: Aetna Government |
$100.04
|
| Rate for Payer: Brighton Health Commercial |
$150.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.05
|
| Rate for Payer: Group Health Inc Commercial |
$100.04
|
| Rate for Payer: Group Health Inc Medicare |
$70.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$130.05
|
|
|
PODOPHYLLUM RESIN 25 % EX SOLN [6356]
|
Facility
|
OP
|
$8.17
|
|
|
Service Code
|
NDC 00574060115
|
| Hospital Charge Code |
00574060115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$6.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Brighton Health Commercial |
$6.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.55
|
| Rate for Payer: Group Health Inc Commercial |
$4.08
|
| Rate for Payer: Group Health Inc Medicare |
$2.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.31
|
|
|
POD ORCA HYDRA 629-50
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
64906824
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.50
|
| Rate for Payer: Aetna Government |
$9.50
|
| Rate for Payer: Brighton Health Commercial |
$14.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.92
|
| Rate for Payer: Group Health Inc Commercial |
$9.50
|
| Rate for Payer: Group Health Inc Medicare |
$6.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.50
|
|
|
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC
|
Facility
|
IP
|
$40,505.84
|
|
|
Service Code
|
MSDRG 917
|
| Min. Negotiated Rate |
$1,529.00 |
| Max. Negotiated Rate |
$40,505.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,529.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,458.79
|
| Rate for Payer: Aetna Government |
$29,458.79
|
| Rate for Payer: Brighton Health Commercial |
$23,140.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$30,047.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,559.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,743.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,985.85
|
| Rate for Payer: EmblemHealth Commercial |
$13,684.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,458.79
|
| Rate for Payer: Group Health Inc Commercial |
$29,458.79
|
| Rate for Payer: Group Health Inc Medicare |
$29,458.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,458.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,698.34
|
| Rate for Payer: Humana Medicare |
$40,505.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,458.79
|
| Rate for Payer: United Healthcare Commercial |
$31,737.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,458.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,458.79
|
| Rate for Payer: Wellcare Medicare |
$27,985.85
|
|
|
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC
|
Facility
|
IP
|
$26,491.14
|
|
|
Service Code
|
MSDRG 918
|
| Min. Negotiated Rate |
$1,529.00 |
| Max. Negotiated Rate |
$26,491.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,529.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,266.28
|
| Rate for Payer: Aetna Government |
$19,266.28
|
| Rate for Payer: Brighton Health Commercial |
$12,483.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,651.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,866.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,268.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,302.97
|
| Rate for Payer: EmblemHealth Commercial |
$7,382.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,266.28
|
| Rate for Payer: Group Health Inc Commercial |
$19,266.28
|
| Rate for Payer: Group Health Inc Medicare |
$19,266.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,266.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,958.82
|
| Rate for Payer: Humana Medicare |
$26,491.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,266.28
|
| Rate for Payer: United Healthcare Commercial |
$17,120.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,266.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,266.28
|
| Rate for Payer: Wellcare Medicare |
$18,302.97
|
|
|
POLARIS STENT URETERAL 6FR X 24CM
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
40209386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
|
|
POLARIS STENT URETERAL 6FR X 24CM
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
40209386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.14
|
| Rate for Payer: Aetna Government |
$10.14
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$175.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$201.25
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
POLARIS STENT URETERAL6FRX 24CM
|
Facility
|
OP
|
$390.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
40209606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$214.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$265.52
|
| Rate for Payer: Aetna Government |
$265.52
|
| Rate for Payer: Brighton Health Commercial |
$234.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$195.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.25
|
| Rate for Payer: EmblemHealth Commercial |
$195.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$409.50
|
| Rate for Payer: Group Health Inc Commercial |
$195.00
|
| Rate for Payer: Group Health Inc Medicare |
$136.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$253.50
|
|
|
POLARIS STENT URETERAL6FRX 24CM
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
40209606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.00
|
|
|
POLARIS STENT URETERAL 6FRX26CM
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
40209389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
|
|
POLARIS STENT URETERAL 6FRX26CM
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
40209389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.14
|
| Rate for Payer: Aetna Government |
$10.14
|
| Rate for Payer: Brighton Health Commercial |
$210.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$175.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$201.25
|
| Rate for Payer: EmblemHealth Commercial |
$175.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$367.50
|
| Rate for Payer: Group Health Inc Commercial |
$175.00
|
| Rate for Payer: Group Health Inc Medicare |
$122.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$175.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$227.50
|
|
|
POLIOVIRUS AB (TYPE 1,2,3)
|
Facility
|
OP
|
$42.28
|
|
|
Service Code
|
HCPCS 86382
|
| Hospital Charge Code |
30305754
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$31.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.91
|
| Rate for Payer: Aetna Government |
$16.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.84
|
| Rate for Payer: Brighton Health Commercial |
$31.71
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.91
|
| Rate for Payer: EmblemHealth Commercial |
$16.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.05
|
| Rate for Payer: Group Health Inc Commercial |
$16.91
|
| Rate for Payer: Group Health Inc Medicare |
$16.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.91
|
| Rate for Payer: Healthfirst QHP |
$16.91
|
| Rate for Payer: Humana Medicare |
$17.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.91
|
| Rate for Payer: United Healthcare Commercial |
$21.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.53
|
| Rate for Payer: Wellcare Medicare |
$15.22
|
|
|
POLIOVIRUS AB (TYPE 1,2,3)
|
Facility
|
IP
|
$42.28
|
|
|
Service Code
|
HCPCS 86382
|
| Hospital Charge Code |
30305754
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$16.91
|
|
