|
BASEPLATE TIBIAL CEMENT SZ3
|
Facility
IP
|
$3,935.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,967.50 |
| Max. Negotiated Rate |
$1,967.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,967.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,967.50
|
|
|
BASEPLATE TIBIAL CEMENT SZ3
|
Facility
OP
|
$3,935.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903266
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,131.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,164.25
|
| 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 |
$1,967.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,262.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,131.75
|
| Rate for Payer: Group Health Inc Commercial |
$1,967.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,377.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,967.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,967.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,557.75
|
|
|
BASIC METABOLIC PANEL
|
Facility
OP
|
$21.15
|
|
|
Service Code
|
HCPCS 80048
|
| Hospital Charge Code |
40602506
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$13.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.46
|
| Rate for Payer: Aetna Government |
$8.46
|
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.46
|
| Rate for Payer: EmblemHealth Commercial |
$8.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.53
|
| Rate for Payer: Group Health Inc Commercial |
$8.46
|
| Rate for Payer: Group Health Inc Medicare |
$8.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.46
|
| Rate for Payer: Healthfirst QHP |
$8.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.77
|
| Rate for Payer: Wellcare Medicare |
$7.61
|
|
|
BASKET 3/4 SIZE
|
Facility
OP
|
$257.25
|
|
| Hospital Charge Code |
64903484
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.04 |
| Max. Negotiated Rate |
$205.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$141.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$128.62
|
| Rate for Payer: Aetna Government |
$128.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$205.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$174.93
|
| Rate for Payer: Group Health Inc Commercial |
$128.62
|
| Rate for Payer: Group Health Inc Medicare |
$90.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.62
|
|
|
BASKET HALF SIZE
|
Facility
OP
|
$246.75
|
|
| Hospital Charge Code |
64903480
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.36 |
| Max. Negotiated Rate |
$197.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$135.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$123.38
|
| Rate for Payer: Aetna Government |
$123.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$197.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$167.79
|
| Rate for Payer: Group Health Inc Commercial |
$123.38
|
| Rate for Payer: Group Health Inc Medicare |
$86.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$123.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.38
|
|
|
BASKET RETRIEV 1.9 ZERO TIP
|
Facility
OP
|
$512.50
|
|
| Hospital Charge Code |
64905747
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$281.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$256.25
|
| Rate for Payer: Aetna Government |
$256.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$410.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$348.50
|
| Rate for Payer: Group Health Inc Commercial |
$256.25
|
| Rate for Payer: Group Health Inc Medicare |
$179.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$256.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$256.25
|
|
|
BASKET SEGURA
|
Facility
OP
|
$549.38
|
|
| Hospital Charge Code |
64907139
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$192.28 |
| Max. Negotiated Rate |
$439.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$302.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$274.69
|
| Rate for Payer: Aetna Government |
$274.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$439.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$373.58
|
| Rate for Payer: Group Health Inc Commercial |
$274.69
|
| Rate for Payer: Group Health Inc Medicare |
$192.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$274.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$274.69
|
|
|
BASKT NIT ZERO-TP 4W 1.9F 120CM
|
Facility
OP
|
$543.75
|
|
| Hospital Charge Code |
64904543
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$190.31 |
| Max. Negotiated Rate |
$435.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$299.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$271.88
|
| Rate for Payer: Aetna Government |
$271.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$435.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$369.75
|
| Rate for Payer: Group Health Inc Commercial |
$271.88
|
| Rate for Payer: Group Health Inc Medicare |
$190.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$271.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$271.88
|
|
|
BATTERY PACK REUSEABLE
|
Facility
OP
|
$2,750.00
|
|
| Hospital Charge Code |
64907078
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$962.50 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,512.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,375.00
|
| Rate for Payer: Aetna Government |
$1,375.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,870.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,375.00
|
| Rate for Payer: Group Health Inc Medicare |
$962.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,375.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,375.00
|
|
|
BATTERY VARISPEED
|
Facility
OP
|
$285.00
|
|
| Hospital Charge Code |
64906326
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$99.75 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$156.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$142.50
|
| Rate for Payer: Aetna Government |
$142.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$228.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$193.80
|
| Rate for Payer: Group Health Inc Commercial |
$142.50
|
| Rate for Payer: Group Health Inc Medicare |
$99.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$142.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$142.50
|
|
|
BAX CYSTO/BLADDER IRRIG SET
|
Facility
OP
|
$160.00
|
|
| Hospital Charge Code |
40204265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.00
|
| Rate for Payer: Aetna Government |
$80.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$128.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$108.80
|
| Rate for Payer: Group Health Inc Commercial |
$80.00
|
| Rate for Payer: Group Health Inc Medicare |
$56.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80.00
|
|
|
BAX FLOSEAL HEMO MATRIX 10 ML
|
Facility
OP
|
$470.46
|
|
| Hospital Charge Code |
40008308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.66 |
| Max. Negotiated Rate |
$376.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$258.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$235.23
|
| Rate for Payer: Aetna Government |
$235.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$376.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$319.91
|
| Rate for Payer: Group Health Inc Commercial |
$235.23
|
| Rate for Payer: Group Health Inc Medicare |
$164.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.23
|
|
|
BAXTER FIBRIN SEALANT (TISSEEL)
|
Facility
OP
|
$1,175.40
|
|
|
Service Code
|
HCPCS C9250
|
| Hospital Charge Code |
40209572
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$106.19 |
| Max. Negotiated Rate |
$764.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$646.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$132.73
|
| Rate for Payer: Aetna Government |
$132.73
|
| Rate for Payer: Cash Price |
$132.73
|
| Rate for Payer: Cash Price |
$132.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$132.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$587.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$675.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$132.73
|
| Rate for Payer: EmblemHealth Commercial |
$132.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$132.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$132.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$139.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$132.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$139.37
|
| Rate for Payer: Group Health Inc Commercial |
$132.73
|
| Rate for Payer: Group Health Inc Medicare |
$132.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$587.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$587.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$112.82
|
| Rate for Payer: Healthfirst QHP |
$132.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$132.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$764.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$106.19
|
| Rate for Payer: Wellcare Medicare |
$126.10
|
|
|
BAXTER FIBRIN SEALANT (TISSEEL)
|
Facility
IP
|
$1,175.40
|
|
|
Service Code
|
HCPCS C9250
|
| Hospital Charge Code |
40209572
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$587.70 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Cash Price |
$132.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$587.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$587.70
|
|
|
BB-TAK THREADED 13226
|
Facility
OP
|
$216.00
|
|
| Hospital Charge Code |
64906645
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$108.00
|
| Rate for Payer: Aetna Government |
$108.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$172.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$146.88
|
| Rate for Payer: Group Health Inc Commercial |
$108.00
|
| Rate for Payer: Group Health Inc Medicare |
$75.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.00
|
|
|
BBT TRAUMA
|
Facility
OP
|
$10,171.88
|
|
| Hospital Charge Code |
64902813
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$3,560.16 |
| Max. Negotiated Rate |
$8,137.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,594.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,085.94
|
| Rate for Payer: Aetna Government |
$5,085.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8,137.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6,916.88
|
| Rate for Payer: Group Health Inc Commercial |
$5,085.94
|
| Rate for Payer: Group Health Inc Medicare |
$3,560.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,085.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,085.94
|
|
|
B. BURGDORFERI IGG/IGM ABS,CSF
|
Facility
OP
|
$42.58
|
|
|
Service Code
|
HCPCS 86618
|
| Hospital Charge Code |
40729351
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$27.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.03
|
| Rate for Payer: Aetna Government |
$17.03
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.03
|
| Rate for Payer: EmblemHealth Commercial |
$17.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.16
|
| Rate for Payer: Group Health Inc Commercial |
$17.03
|
| Rate for Payer: Group Health Inc Medicare |
$17.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.03
|
| Rate for Payer: Healthfirst QHP |
$17.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.62
|
| Rate for Payer: Wellcare Medicare |
$15.33
|
|
|
BCG VACCINE 50MG (NF)
|
Facility
OP
|
$222.52
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41659547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$144.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$122.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$111.26
|
| Rate for Payer: Aetna Government |
$111.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$111.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.95
|
| Rate for Payer: Group Health Inc Commercial |
$111.26
|
| Rate for Payer: Group Health Inc Medicare |
$77.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.64
|
|
|
BCG VACCINE 50MG (NF)
|
Facility
IP
|
$222.52
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41649547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.26 |
| Max. Negotiated Rate |
$111.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.26
|
|
|
BCG VACCINE 50MG (NF)
|
Facility
OP
|
$222.52
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41649547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$144.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$122.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$111.26
|
| Rate for Payer: Aetna Government |
$111.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$111.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$127.95
|
| Rate for Payer: Group Health Inc Commercial |
$111.26
|
| Rate for Payer: Group Health Inc Medicare |
$77.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.64
|
|
|
BCG VACCINE 50MG (NF)
|
Facility
IP
|
$222.52
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41659547
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.26 |
| Max. Negotiated Rate |
$111.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$111.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.26
|
|
|
BCG VACCINE,PERCUTANEOUS
|
Facility
OP
|
$56.70
|
|
|
Service Code
|
HCPCS 90585
|
| Hospital Charge Code |
30300148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$160.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$160.21
|
| Rate for Payer: Aetna Government |
$160.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.60
|
| Rate for Payer: Group Health Inc Commercial |
$28.35
|
| Rate for Payer: Group Health Inc Medicare |
$19.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.86
|
|
|
BCG VACCINE,PERCUTANEOUS
|
Facility
IP
|
$56.70
|
|
|
Service Code
|
HCPCS 90585
|
| Hospital Charge Code |
30300148
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$28.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.35
|
|
|
BCR/ABL1 GENE MAJOR BP
|
Facility
OP
|
$409.90
|
|
|
Service Code
|
HCPCS 81206
|
| Hospital Charge Code |
30305425
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$131.17 |
| Max. Negotiated Rate |
$327.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$225.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$163.96
|
| Rate for Payer: Aetna Government |
$163.96
|
| Rate for Payer: Brighton Health Commercial |
$163.96
|
| Rate for Payer: Cash Price |
$163.96
|
| Rate for Payer: Cash Price |
$163.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$163.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$327.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$278.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$163.96
|
| Rate for Payer: EmblemHealth Commercial |
$163.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$147.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$139.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$145.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$163.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$145.92
|
| Rate for Payer: Group Health Inc Commercial |
$163.96
|
| Rate for Payer: Group Health Inc Medicare |
$163.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$204.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$163.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.96
|
| Rate for Payer: Healthfirst QHP |
$163.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$163.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$163.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$131.17
|
| Rate for Payer: Wellcare Medicare |
$147.56
|
|
|
BCR/ABL1 GENE MINOR BP
|
Facility
OP
|
$362.10
|
|
|
Service Code
|
HCPCS 81207
|
| Hospital Charge Code |
30305426
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$115.87 |
| Max. Negotiated Rate |
$289.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$199.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$144.84
|
| Rate for Payer: Aetna Government |
$144.84
|
| Rate for Payer: Brighton Health Commercial |
$144.84
|
| Rate for Payer: Cash Price |
$144.84
|
| Rate for Payer: Cash Price |
$144.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$144.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$289.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$246.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$144.84
|
| Rate for Payer: EmblemHealth Commercial |
$144.84
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$130.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$123.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$128.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$144.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$128.91
|
| Rate for Payer: Group Health Inc Commercial |
$144.84
|
| Rate for Payer: Group Health Inc Medicare |
$144.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$144.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$144.84
|
| Rate for Payer: Healthfirst QHP |
$144.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$144.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$144.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$115.87
|
| Rate for Payer: Wellcare Medicare |
$130.36
|
|
