|
ATROPINE 1% OPHTHALMIC SOLN
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41653540
|
|
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
|
|
|
ATROPINE 1% OPHTHALMIC SOLN
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41643540
|
|
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
|
|
|
ATROPINE-PRALIDOXIME INJ
|
Facility
OP
|
$78.00
|
|
| Hospital Charge Code |
41654785
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.00
|
| Rate for Payer: Aetna Government |
$39.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.04
|
| Rate for Payer: Group Health Inc Commercial |
$39.00
|
| Rate for Payer: Group Health Inc Medicare |
$27.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.70
|
|
|
ATROPINE-PRALIDOXIME INJ
|
Facility
OP
|
$78.00
|
|
| Hospital Charge Code |
41644785
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.00
|
| Rate for Payer: Aetna Government |
$39.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.04
|
| Rate for Payer: Group Health Inc Commercial |
$39.00
|
| Rate for Payer: Group Health Inc Medicare |
$27.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.70
|
|
|
ATROVEN Q8H PRN
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306314
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ATROVENT BID
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306310
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ATROVENT BID PRN
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306316
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ATROVENT Q4H
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306306
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ATROVENT Q4H PRN
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306312
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ATROVENT Q6H
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306307
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ATROVENT Q6H PRN
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306313
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ATROVENT Q8H
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306308
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ATROVENT QID
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306309
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ATROVENT QID PRN
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306346
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ATROVENT TID
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306311
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ATROVENT TID PRN
|
Facility
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40306317
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.31 |
| Max. Negotiated Rate |
$306.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
ATS BLOOD BAG, REINFUSION
|
Facility
OP
|
$70.33
|
|
| Hospital Charge Code |
64901756
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.62 |
| Max. Negotiated Rate |
$56.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.16
|
| Rate for Payer: Aetna Government |
$35.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.82
|
| Rate for Payer: Group Health Inc Commercial |
$35.16
|
| Rate for Payer: Group Health Inc Medicare |
$24.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.16
|
|
|
ATTAIN BALLOON CATHETER 6215
|
Facility
OP
|
$241.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66570515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$253.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$138.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$253.31
|
| Rate for Payer: Group Health Inc Commercial |
$120.62
|
| Rate for Payer: Group Health Inc Medicare |
$84.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.81
|
|
|
ATTAIN BALLOON CATHETER 6215
|
Facility
IP
|
$241.25
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66570515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$120.62 |
| Max. Negotiated Rate |
$120.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.62
|
|
|
ATTAIN PERFOMA LEAD SYSTEM
|
Facility
IP
|
$6,562.50
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
66570513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,281.25 |
| Max. Negotiated Rate |
$3,281.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,281.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,281.25
|
|
|
ATTAIN PERFOMA LEAD SYSTEM
|
Facility
OP
|
$6,562.50
|
|
|
Service Code
|
HCPCS C1900
|
| Hospital Charge Code |
66570513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.84 |
| Max. Negotiated Rate |
$6,890.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,609.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.84
|
| Rate for Payer: Aetna Government |
$98.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,281.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,773.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,890.62
|
| Rate for Payer: Group Health Inc Commercial |
$3,281.25
|
| Rate for Payer: Group Health Inc Medicare |
$2,296.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,281.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,281.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,265.62
|
|
|
ATTAIN SELECT SUREVALVE 130L
|
Facility
OP
|
$658.12
|
|
| Hospital Charge Code |
66570516
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$230.34 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$361.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$329.06
|
| Rate for Payer: Aetna Government |
$329.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$526.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$447.52
|
| Rate for Payer: Group Health Inc Commercial |
$329.06
|
| Rate for Payer: Group Health Inc Medicare |
$230.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$329.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$329.06
|
|
|
ATYPICAL PANCA
|
Facility
OP
|
$30.13
|
|
|
Service Code
|
HCPCS 86037
|
| Hospital Charge Code |
40729917
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$24.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.05
|
| Rate for Payer: Aetna Government |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.05
|
| Rate for Payer: EmblemHealth Commercial |
$12.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.72
|
| Rate for Payer: Group Health Inc Commercial |
$12.05
|
| Rate for Payer: Group Health Inc Medicare |
$12.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.05
|
| Rate for Payer: Healthfirst QHP |
$12.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.64
|
| Rate for Payer: Wellcare Medicare |
$10.84
|
|
|
AUGMENTATION OF FACIAL BONES
|
Facility
OP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 21208
|
| Hospital Charge Code |
40019891
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$792.29 |
| Max. Negotiated Rate |
$7,345.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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 |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$792.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$880.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
AUGMENT FEMORAL SIZE 4 5MM
|
Facility
OP
|
$4,550.00
|
|
| Hospital Charge Code |
64905989
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1,592.50 |
| Max. Negotiated Rate |
$3,640.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,502.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,275.00
|
| Rate for Payer: Aetna Government |
$2,275.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,640.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,094.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,275.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,592.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,275.00
|
|
