|
ASNIS CAN. SCRW SS4.0X40MM 1/3 TH
|
Facility
IP
|
$291.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.90 |
| Max. Negotiated Rate |
$145.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.90
|
|
|
ASNIS CAN. SCRW SS4.0X40MM 1/3 TH
|
Facility
OP
|
$291.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205471
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$102.13 |
| Max. Negotiated Rate |
$306.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$160.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$145.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$167.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$306.39
|
| Rate for Payer: Group Health Inc Commercial |
$145.90
|
| Rate for Payer: Group Health Inc Medicare |
$102.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.67
|
|
|
ASNIS CAN SCRW SS4.0X44MM 1/3 TH
|
Facility
IP
|
$291.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.60 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.60
|
|
|
ASNIS CAN SCRW SS4.0X44MM 1/3 TH
|
Facility
OP
|
$291.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$305.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$160.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$145.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$167.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$305.76
|
| Rate for Payer: Group Health Inc Commercial |
$145.60
|
| Rate for Payer: Group Health Inc Medicare |
$101.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$145.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$145.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$189.28
|
|
|
ASNIS CAN. SCRW SS4.0X46/50
|
Facility
OP
|
$313.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$109.76 |
| Max. Negotiated Rate |
$329.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$172.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$156.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$180.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$329.28
|
| Rate for Payer: Group Health Inc Commercial |
$156.80
|
| Rate for Payer: Group Health Inc Medicare |
$109.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$203.84
|
|
|
ASNIS CAN. SCRW SS4.0X46/50
|
Facility
IP
|
$313.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40205396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$156.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.80
|
|
|
ASNIS III 6.5/8.0 GUIDE WIRE
|
Facility
IP
|
$368.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$184.38 |
| Max. Negotiated Rate |
$184.38 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
|
|
ASNIS III 6.5/8.0 GUIDE WIRE
|
Facility
OP
|
$368.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903565
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.06 |
| Max. Negotiated Rate |
$387.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$202.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$184.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$212.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$387.19
|
| Rate for Payer: Group Health Inc Commercial |
$184.38
|
| Rate for Payer: Group Health Inc Medicare |
$129.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$184.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$184.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$239.69
|
|
|
ASPERGILLUS AB, QN, DID
|
Facility
OP
|
$37.63
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
40729347
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.05
|
| Rate for Payer: Aetna Government |
$15.05
|
| Rate for Payer: Cash Price |
$15.05
|
| Rate for Payer: Cash Price |
$15.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.05
|
| Rate for Payer: EmblemHealth Commercial |
$15.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.39
|
| Rate for Payer: Group Health Inc Commercial |
$15.05
|
| Rate for Payer: Group Health Inc Medicare |
$15.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.05
|
| Rate for Payer: Healthfirst QHP |
$15.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.04
|
| Rate for Payer: Wellcare Medicare |
$13.54
|
|
|
ASPERGILLUS AG BAL/SERUM
|
Facility
OP
|
$517.50
|
|
|
Service Code
|
HCPCS 87305
|
| Hospital Charge Code |
40601158
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$284.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$284.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.98
|
| Rate for Payer: Aetna Government |
$11.98
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Cash Price |
$11.98
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.98
|
| 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 |
$11.98
|
| Rate for Payer: EmblemHealth Commercial |
$11.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.66
|
| Rate for Payer: Group Health Inc Commercial |
$11.98
|
| Rate for Payer: Group Health Inc Medicare |
$11.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$258.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.98
|
| Rate for Payer: Healthfirst QHP |
$11.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.58
|
| Rate for Payer: Wellcare Medicare |
$10.78
|
|
|
ASPERGILUS AB PROFILE
|
Facility
OP
|
$37.63
|
|
|
Service Code
|
HCPCS 86606
|
| Hospital Charge Code |
40728122
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.05
|
| Rate for Payer: Aetna Government |
$15.05
|
| Rate for Payer: Cash Price |
$15.05
|
| Rate for Payer: Cash Price |
$15.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.05
|
| Rate for Payer: EmblemHealth Commercial |
$15.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.39
|
| Rate for Payer: Group Health Inc Commercial |
$15.05
|
| Rate for Payer: Group Health Inc Medicare |
$15.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.05
|
| Rate for Payer: Healthfirst QHP |
$15.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.04
|
| Rate for Payer: Wellcare Medicare |
$13.54
|
|
|
ASPIRATE/INJ GANGLION CYST
|
Facility
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 20612
|
| Hospital Charge Code |
30305200
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.11 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$342.51
|
| Rate for Payer: Aetna Government |
$342.51
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Cash Price |
$342.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$342.51
|
| 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 |
$342.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$45.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$291.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$342.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$304.83
|
| 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 |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$342.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$291.13
|
| Rate for Payer: Healthfirst QHP |
$342.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$342.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$342.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$342.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$274.01
|
| Rate for Payer: Wellcare Medicare |
$325.38
|
|
|
ASPIRATION CATH MEDTRONIC GUARDWI
|
Facility
IP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
66522107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,575.00 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,575.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,575.00
|
|
|
ASPIRATION CATH MEDTRONIC GUARDWI
|
Facility
OP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
66522107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16.33 |
| Max. Negotiated Rate |
$3,307.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,732.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.33
|
| Rate for Payer: Aetna Government |
$16.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,575.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,811.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,307.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,575.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,102.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,575.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,575.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,047.50
|
|
|
Aspiration of bladder; with insertion of suprapubic catheter
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 51102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.16 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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 |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$2,355.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$153.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
ASPIRATOR MECONIUM N0101
|
Facility
OP
|
$9.01
|
|
| Hospital Charge Code |
64902328
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$7.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.50
|
| Rate for Payer: Aetna Government |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.13
|
| Rate for Payer: Group Health Inc Commercial |
$4.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
|
|
ASPIRATOR W / VTD TIP 0.7-1.7
|
Facility
OP
|
$1.55
|
|
| Hospital Charge Code |
64902062
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.78
|
|
|
ASPIRIN 300 MG SUPPOSITORY
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41655153
|
|
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: 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
|
|
|
ASPIRIN 300 MG SUPPOSITORY
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41645153
|
|
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: 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
|
|
|
ASPIRIN 325 MG ENTERIC COATED TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650103
|
|
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: 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
|
|
|
ASPIRIN 325 MG ENTERIC COATED TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640103
|
|
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: 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
|
|
|
ASPIRIN 325 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41643510
|
|
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: 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
|
|
|
ASPIRIN 325 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41653510
|
|
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: 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
|
|
|
ASPIRIN 81 MG CHEWABLE TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650294
|
|
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: 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
|
|
|
ASPIRIN 81 MG CHEWABLE TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640294
|
|
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: 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
|
|
