|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$23,741.56
|
|
|
Service Code
|
MSDRG 776
|
| Min. Negotiated Rate |
$6,145.70 |
| Max. Negotiated Rate |
$23,741.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,567.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,266.59
|
| Rate for Payer: Aetna Government |
$17,266.59
|
| Rate for Payer: Brighton Health Commercial |
$10,392.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,611.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,376.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,213.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,403.26
|
| Rate for Payer: EmblemHealth Commercial |
$6,145.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,266.59
|
| Rate for Payer: Group Health Inc Commercial |
$17,266.59
|
| Rate for Payer: Group Health Inc Medicare |
$17,266.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,266.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,028.96
|
| Rate for Payer: Humana Medicare |
$23,741.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,266.59
|
| Rate for Payer: United Healthcare Commercial |
$14,253.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,266.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,266.59
|
| Rate for Payer: Wellcare Medicare |
$16,403.26
|
|
|
POSTPARTUM CARE VISIT
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS 0503F
|
| Hospital Charge Code |
30304031
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
POSTPARTUM ONLY(SEP PROC)
|
Facility
|
OP
|
$415.16
|
|
|
Service Code
|
HCPCS 59430
|
| Hospital Charge Code |
30301248
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$167.47 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$167.47
|
| Rate for Payer: Aetna Government |
$167.47
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.58
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
POST PIN
|
Facility
|
OP
|
$1,452.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,524.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$798.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$871.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$726.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$834.90
|
| Rate for Payer: EmblemHealth Commercial |
$726.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,524.60
|
| Rate for Payer: Group Health Inc Commercial |
$726.00
|
| Rate for Payer: Group Health Inc Medicare |
$508.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$726.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$943.80
|
|
|
POST PIN
|
Facility
|
IP
|
$1,452.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200763
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.00 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$726.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.00
|
|
|
POST REMOVAL-NOT IN CONJ. W/ ENDO
|
Facility
|
OP
|
$237.50
|
|
|
Service Code
|
HCPCS D2955
|
| Hospital Charge Code |
42303298
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.98
|
| Rate for Payer: Aetna Government |
$67.98
|
| Rate for Payer: Brighton Health Commercial |
$178.12
|
| 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: Group Health Inc Commercial |
$118.75
|
| Rate for Payer: Group Health Inc Medicare |
$83.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.75
|
|
|
POST STRAIGHT
|
Facility
|
OP
|
$171.00
|
|
| Hospital Charge Code |
40200764
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.50
|
| Rate for Payer: Aetna Government |
$85.50
|
| Rate for Payer: Brighton Health Commercial |
$128.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$136.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.28
|
| Rate for Payer: Group Health Inc Commercial |
$85.50
|
| Rate for Payer: Group Health Inc Medicare |
$59.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.50
|
|
|
POST TREATMENT RPR
|
Facility
|
IP
|
$10.68
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
40721422
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$4.27
|
|
|
POST TREATMENT RPR
|
Facility
|
OP
|
$10.68
|
|
|
Service Code
|
HCPCS 86592
|
| Hospital Charge Code |
40721422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$8.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.27
|
| Rate for Payer: Aetna Government |
$4.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.99
|
| Rate for Payer: Brighton Health Commercial |
$8.01
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Cash Price |
$4.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.27
|
| Rate for Payer: EmblemHealth Commercial |
$4.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.80
|
| Rate for Payer: Group Health Inc Commercial |
$4.27
|
| Rate for Payer: Group Health Inc Medicare |
$4.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.27
|
| Rate for Payer: Healthfirst QHP |
$4.27
|
| Rate for Payer: Humana Medicare |
$4.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.42
|
| Rate for Payer: Wellcare Medicare |
$3.84
|
|
|
POST TX TALO TARSEL DISLOCATE RED
|
Facility
|
OP
|
$659.05
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
30107555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.71
|
| Rate for Payer: Aetna Government |
$272.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$190.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$190.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$190.90
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$272.71
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Cash Price |
$272.71
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$272.71
|
| 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 |
$272.71
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$231.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$242.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$272.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$242.71
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$329.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$272.71
|
| Rate for Payer: Humana Medicare |
$278.16
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$272.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$272.71
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$272.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$272.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$218.17
|
| Rate for Payer: Wellcare Medicare |
$259.07
|
|
|
POST TX TALO TARSEL DISLOCATE RED
|
Facility
|
IP
|
$659.05
|
|
|
Service Code
|
HCPCS 28570
|
| Hospital Charge Code |
30107555
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$272.71
|
|
|
POST WIRE HOFFMANN II HYBIRD
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40201408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$258.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Brighton Health Commercial |
$282.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$235.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.25
|
| Rate for Payer: EmblemHealth Commercial |
$235.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$493.50
|
| Rate for Payer: Group Health Inc Commercial |
$235.00
|
| Rate for Payer: Group Health Inc Medicare |
$164.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.50
|
|
|
POST WIRE HOFFMANN II HYBIRD
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40201408
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.00 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.00
|
|
|
POTASIUM K (SERUMELECTROLYTS)
|
Facility
|
OP
|
$11.90
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
40602065
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.33 |
| Max. Negotiated Rate |
$8.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.76
|
| Rate for Payer: Aetna Government |
$4.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.33
|
| Rate for Payer: Brighton Health Commercial |
$8.92
|
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: Cash Price |
$4.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.19
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.76
|
| Rate for Payer: EmblemHealth Commercial |
$4.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.24
|
| Rate for Payer: Group Health Inc Commercial |
$4.76
|
| Rate for Payer: Group Health Inc Medicare |
$4.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.76
|
| Rate for Payer: Healthfirst QHP |
$4.76
|
| Rate for Payer: Humana Medicare |
$4.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.76
|
| Rate for Payer: United Healthcare Commercial |
$5.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.81
|
| Rate for Payer: Wellcare Medicare |
$4.28
|
|
|
POTASIUM K (SERUMELECTROLYTS)
|
Facility
|
IP
|
$11.90
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
40602065
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$4.76
|
|
|
POTASSIUM
|
Facility
|
OP
|
$2.48
|
|
| Hospital Charge Code |
42905050
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.24
|
| Rate for Payer: Aetna Government |
$1.24
|
| Rate for Payer: Brighton Health Commercial |
$1.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.69
|
| Rate for Payer: Group Health Inc Commercial |
$1.24
|
| Rate for Payer: Group Health Inc Medicare |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.24
|
|
|
POTASSIUM 24 HOUR URINE
|
Facility
|
OP
|
$11.83
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
40602620
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$8.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.73
|
| Rate for Payer: Aetna Government |
$4.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.31
|
| Rate for Payer: Brighton Health Commercial |
$8.87
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Cash Price |
$4.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.79
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.73
|
| Rate for Payer: EmblemHealth Commercial |
$4.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.21
|
| Rate for Payer: Group Health Inc Commercial |
$4.73
|
| Rate for Payer: Group Health Inc Medicare |
$4.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.73
|
| Rate for Payer: Healthfirst QHP |
$4.73
|
| Rate for Payer: Humana Medicare |
$4.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.73
|
| Rate for Payer: United Healthcare Commercial |
$5.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.78
|
| Rate for Payer: Wellcare Medicare |
$4.26
|
|
|
POTASSIUM 24 HOUR URINE
|
Facility
|
IP
|
$11.83
|
|
|
Service Code
|
HCPCS 84133
|
| Hospital Charge Code |
40602620
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$4.73
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INJ
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41653807
|
|
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
|
|
|
POTASSIUM ACETATE 2 MEQ/ML INJ
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41643807
|
|
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
|
|
|
POTASSIUM ACETATE 2 MEQ/ML IV SOLN [6420]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 00409818301
|
| Hospital Charge Code |
00409818301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: EmblemHealth Commercial |
$0.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.22
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
POTASSIUM ACETATE 2 MEQ/ML IV SOLN [6420]
|
Facility
|
OP
|
$0.32
|
|
|
Service Code
|
NDC 51754200104
|
| Hospital Charge Code |
51754200104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.16
|
| Rate for Payer: Aetna Government |
$0.16
|
| Rate for Payer: Brighton Health Commercial |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.19
|
| Rate for Payer: EmblemHealth Commercial |
$0.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.16
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.21
|
|
|
POTASSIUM ACETATE 2 MEQ/ML IV SOLN [6420]
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 00409818311
|
| Hospital Charge Code |
00409818311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
|
|
POTASSIUM ACETATE 2 MEQ/ML IV SOLN [6420]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 00409818311
|
| Hospital Charge Code |
00409818311
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: EmblemHealth Commercial |
$0.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.22
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
POTASSIUM ACETATE 2 MEQ/ML IV SOLN [6420]
|
Facility
|
IP
|
$0.21
|
|
|
Service Code
|
NDC 00409818301
|
| Hospital Charge Code |
00409818301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
|
