|
BEDSIDE SPIROMETRY
|
Facility
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 94150 TC
|
| Hospital Charge Code |
40307150
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$146.66 |
| Max. Negotiated Rate |
$335.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.52
|
| Rate for Payer: Aetna Government |
$209.52
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.94
|
| Rate for Payer: Group Health Inc Commercial |
$209.52
|
| Rate for Payer: Group Health Inc Medicare |
$146.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.52
|
|
|
BED ZONE AIR WITH SCALE
|
Facility
OP
|
$2.50
|
|
| Hospital Charge Code |
64902958
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.25
|
| Rate for Payer: Aetna Government |
$1.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.25
|
|
|
BEHAVIORAL AND DEVELOPMENTAL DISORDERS
|
Facility
IP
|
$31,261.59
|
|
|
Service Code
|
MS-DRG 886
|
| Min. Negotiated Rate |
$905.00 |
| Max. Negotiated Rate |
$31,261.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,859.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30,648.62
|
| Rate for Payer: Aetna Government |
$30,648.62
|
| Rate for Payer: Brighton Health Commercial |
$24,384.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$31,261.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29,041.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23,966.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$29,116.19
|
| Rate for Payer: EmblemHealth Commercial |
$905.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$30,648.62
|
| Rate for Payer: Group Health Inc Commercial |
$30,648.62
|
| Rate for Payer: Group Health Inc Medicare |
$30,648.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30,648.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,251.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$30,648.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30,648.62
|
| Rate for Payer: Wellcare Medicare |
$29,116.19
|
|
|
BEHAVIORAL HEALTH SCREENING
|
Facility
OP
|
$450.70
|
|
|
Service Code
|
HCPCS H0002
|
| Hospital Charge Code |
30400239
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$360.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.78
|
| Rate for Payer: Aetna Government |
$45.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.48
|
| Rate for Payer: Group Health Inc Commercial |
$225.35
|
| Rate for Payer: Group Health Inc Medicare |
$157.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.35
|
|
|
BEHAVIOR COUNSEL OBESITY 15 MIN
|
Facility
OP
|
$237.88
|
|
|
Service Code
|
HCPCS G0447
|
| Hospital Charge Code |
30305579
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103.08
|
| Rate for Payer: Aetna Government |
$103.08
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Cash Price |
$103.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$103.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$87.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$103.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.74
|
| 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 |
$118.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$87.62
|
| Rate for Payer: Healthfirst QHP |
$103.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$103.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.46
|
| Rate for Payer: Wellcare Medicare |
$97.93
|
|
|
BEHAVIOR MANAGEMENT,BY REPORT
|
Facility
OP
|
$72.50
|
|
|
Service Code
|
HCPCS D9920
|
| Hospital Charge Code |
42300757
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.32
|
| Rate for Payer: Aetna Government |
$27.32
|
| 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 |
$36.25
|
| Rate for Payer: Group Health Inc Medicare |
$25.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.25
|
|
|
BEHAVIOR SESSION EACH ADDL 15MINS
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS 96165
|
| Hospital Charge Code |
30300362
|
|
Hospital Revenue Code
|
915
|
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.22
|
| Rate for Payer: Aetna Government |
$3.22
|
| Rate for Payer: Amida Care Medicaid |
$14.52
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$14.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,452.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.52
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.25
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.52
|
| Rate for Payer: Healthfirst Essential Plan |
$32.67
|
| Rate for Payer: Healthfirst QHP |
$14.52
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$14.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$32.96
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$32.96
|
| Rate for Payer: Optum Medicaid |
$14.65
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$14.52
|
| Rate for Payer: SOMOS Essential |
$32.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.52
|
|
|
BEHAVIOR SMG CHANGE 10 MIN
|
Facility
OP
|
$82.75
|
|
|
Service Code
|
HCPCS 99407
|
| Hospital Charge Code |
30400244
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$26.31 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.18
|
| Rate for Payer: Aetna Government |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.53
|
| 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 |
$41.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.20
|
| Rate for Payer: Healthfirst QHP |
$33.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.54
|
| Rate for Payer: Wellcare Medicare |
$31.52
|
|
|
BEHAVIOR SMG CHANGE 30-10 MIN
|
Facility
OP
|
$82.75
|
|
|
Service Code
|
HCPCS 99406
|
| Hospital Charge Code |
30400243
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.18
|
| Rate for Payer: Aetna Government |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.53
|
| 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 |
$41.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.20
|
| Rate for Payer: Healthfirst QHP |
$33.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.54
|
| Rate for Payer: Wellcare Medicare |
$31.52
|
|
|
BELIMUMAB PD VIAL 120MG
|
Facility
OP
|
$55.83
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
41650278
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$4,095.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.00
|
| Rate for Payer: Aetna Government |
$52.00
|
| Rate for Payer: Amida Care Medicaid |
$40.95
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$52.00
|
| Rate for Payer: EmblemHealth Commercial |
$52.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,095.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.00
|
| Rate for Payer: Group Health Inc Commercial |
$52.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.95
|
| Rate for Payer: Healthfirst Essential Plan |
$40.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.20
|
| Rate for Payer: Healthfirst QHP |
$40.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.95
|
| Rate for Payer: SOMOS Essential |
$40.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41.60
|
| Rate for Payer: Wellcare Medicare |
$49.40
|
|
|
BELIMUMAB PD VIAL 120MG
|
Facility
OP
|
$55.83
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
41640278
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$4,095.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.00
|
| Rate for Payer: Aetna Government |
$52.00
|
| Rate for Payer: Amida Care Medicaid |
$40.95
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$52.00
|
| Rate for Payer: EmblemHealth Commercial |
$52.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,095.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.00
|
| Rate for Payer: Group Health Inc Commercial |
$52.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.95
|
| Rate for Payer: Healthfirst Essential Plan |
$40.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.20
|
| Rate for Payer: Healthfirst QHP |
$40.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.95
|
| Rate for Payer: SOMOS Essential |
$40.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41.60
|
| Rate for Payer: Wellcare Medicare |
$49.40
|
|
|
BELIMUMAB PD VIAL 120MG
|
Facility
IP
|
$55.83
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
41640278
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$27.92 |
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.92
|
|
|
BELIMUMAB PD VIAL 120MG
|
Facility
IP
|
$55.83
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
41650278
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$27.92 |
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.92
|
|
|
BELIMUMAB PD VIAL 200MG
|
Facility
IP
|
$49.78
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
41640277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.89
|
|
|
BELIMUMAB PD VIAL 200MG
|
Facility
OP
|
$49.78
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
41640277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$4,095.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.00
|
| Rate for Payer: Aetna Government |
$52.00
|
| Rate for Payer: Amida Care Medicaid |
$40.95
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$52.00
|
| Rate for Payer: EmblemHealth Commercial |
$52.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,095.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.00
|
| Rate for Payer: Group Health Inc Commercial |
$52.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.95
|
| Rate for Payer: Healthfirst Essential Plan |
$40.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.20
|
| Rate for Payer: Healthfirst QHP |
$40.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.95
|
| Rate for Payer: SOMOS Essential |
$40.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41.60
|
| Rate for Payer: Wellcare Medicare |
$49.40
|
|
|
BELIMUMAB PD VIAL 200MG
|
Facility
OP
|
$49.78
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
41650277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$4,095.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.00
|
| Rate for Payer: Aetna Government |
$52.00
|
| Rate for Payer: Amida Care Medicaid |
$40.95
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$52.00
|
| Rate for Payer: EmblemHealth Commercial |
$52.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,095.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.00
|
| Rate for Payer: Group Health Inc Commercial |
$52.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.95
|
| Rate for Payer: Healthfirst Essential Plan |
$40.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.20
|
| Rate for Payer: Healthfirst QHP |
$40.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.95
|
| Rate for Payer: SOMOS Essential |
$40.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41.60
|
| Rate for Payer: Wellcare Medicare |
$49.40
|
|
|
BELIMUMAB PD VIAL 200MG
|
Facility
IP
|
$49.78
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
41650277
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$24.89 |
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.89
|
|
|
BELIMUMAB PD VIAL 400MG
|
Facility
IP
|
$55.83
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
41650279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$27.92 |
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.92
|
|
|
BELIMUMAB PD VIAL 400MG
|
Facility
OP
|
$55.83
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
41640279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$4,095.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.00
|
| Rate for Payer: Aetna Government |
$52.00
|
| Rate for Payer: Amida Care Medicaid |
$40.95
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$52.00
|
| Rate for Payer: EmblemHealth Commercial |
$52.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,095.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.00
|
| Rate for Payer: Group Health Inc Commercial |
$52.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.95
|
| Rate for Payer: Healthfirst Essential Plan |
$40.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.20
|
| Rate for Payer: Healthfirst QHP |
$40.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.95
|
| Rate for Payer: SOMOS Essential |
$40.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41.60
|
| Rate for Payer: Wellcare Medicare |
$49.40
|
|
|
BELIMUMAB PD VIAL 400MG
|
Facility
OP
|
$55.83
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
41650279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$4,095.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.00
|
| Rate for Payer: Aetna Government |
$52.00
|
| Rate for Payer: Amida Care Medicaid |
$40.95
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$52.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$52.00
|
| Rate for Payer: EmblemHealth Commercial |
$52.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,095.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$52.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.00
|
| Rate for Payer: Group Health Inc Commercial |
$52.00
|
| Rate for Payer: Group Health Inc Medicare |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.95
|
| Rate for Payer: Healthfirst Essential Plan |
$40.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$44.20
|
| Rate for Payer: Healthfirst QHP |
$40.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.95
|
| Rate for Payer: SOMOS Essential |
$40.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$41.60
|
| Rate for Payer: Wellcare Medicare |
$49.40
|
|
|
BELIMUMAB PD VIAL 400MG
|
Facility
IP
|
$55.83
|
|
|
Service Code
|
HCPCS J0490
|
| Hospital Charge Code |
41640279
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.92 |
| Max. Negotiated Rate |
$27.92 |
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.92
|
|
|
BELLADONNA ALKALOIDS + PHENOBARBITAL ELI
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41655252
|
|
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
|
|
|
BELLADONNA ALKALOIDS + PHENOBARBITAL ELI
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41645252
|
|
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
|
|
|
BELLADONNA + PHENOBARBITAL TAB
|
Facility
OP
|
$0.09
|
|
| Hospital Charge Code |
41643396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
BELLADONNA + PHENOBARBITAL TAB
|
Facility
OP
|
$0.09
|
|
| Hospital Charge Code |
41653396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
