|
SNARE POLY 2.4MM SM OVAL
|
Facility
OP
|
$18.86
|
|
| Hospital Charge Code |
64906815
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$15.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.43
|
| Rate for Payer: Aetna Government |
$9.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.82
|
| Rate for Payer: Group Health Inc Commercial |
$9.43
|
| Rate for Payer: Group Health Inc Medicare |
$6.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.43
|
|
|
SNARE ROTATING 20MM , MINI STD
|
Facility
OP
|
$103.00
|
|
| Hospital Charge Code |
40209779
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$82.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.50
|
| Rate for Payer: Aetna Government |
$51.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$70.04
|
| Rate for Payer: Group Health Inc Commercial |
$51.50
|
| Rate for Payer: Group Health Inc Medicare |
$36.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.50
|
|
|
SNARE ROTATING MICRO OVAL 13MM
|
Facility
OP
|
$126.06
|
|
| Hospital Charge Code |
64903946
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.12 |
| Max. Negotiated Rate |
$100.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.03
|
| Rate for Payer: Aetna Government |
$63.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$100.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.72
|
| Rate for Payer: Group Health Inc Commercial |
$63.03
|
| Rate for Payer: Group Health Inc Medicare |
$44.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.03
|
|
|
SNARE SHRT THR STD OV 30MM 40BX
|
Facility
OP
|
$66.31
|
|
| Hospital Charge Code |
64904458
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$23.21 |
| Max. Negotiated Rate |
$53.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.16
|
| Rate for Payer: Aetna Government |
$33.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$45.09
|
| Rate for Payer: Group Health Inc Commercial |
$33.16
|
| Rate for Payer: Group Health Inc Medicare |
$23.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.16
|
|
|
S NON LOCKING SCRW 3.5X18MM
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$61.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$117.60
|
| Rate for Payer: Group Health Inc Commercial |
$56.00
|
| Rate for Payer: Group Health Inc Medicare |
$39.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.80
|
|
|
S NON LOCKING SCRW 3.5X18MM
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40205022
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.00
|
|
|
S&N OXINUM 36MM+12/14 TAPER HEAD
|
Facility
OP
|
$3,936.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40006500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$4,132.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,164.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,968.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,263.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,132.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,968.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,377.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,968.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,968.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,558.40
|
|
|
S&N OXINUM 36MM+12/14 TAPER HEAD
|
Facility
IP
|
$3,936.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40006500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,968.00 |
| Max. Negotiated Rate |
$1,968.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,968.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,968.00
|
|
|
S&N RESURF PATELLAR 32MMX7.5MM
|
Facility
IP
|
$3,210.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40006507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,605.00 |
| Max. Negotiated Rate |
$1,605.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,605.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,605.00
|
|
|
S&N RESURF PATELLAR 32MMX7.5MM
|
Facility
OP
|
$3,210.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40006507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,370.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,765.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,605.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,845.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,370.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,605.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,123.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,605.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,605.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,086.50
|
|
|
S/N TROCAR K-WIRE
|
Facility
OP
|
$49.58
|
|
| Hospital Charge Code |
40205817
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$39.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.79
|
| Rate for Payer: Aetna Government |
$24.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.71
|
| Rate for Payer: Group Health Inc Commercial |
$24.79
|
| Rate for Payer: Group Health Inc Medicare |
$17.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.79
|
|
|
SOBIOPSY SOFT TISSUE NECK/THROAT
|
Facility
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 21550
|
| Hospital Charge Code |
30306660
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$172.60 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| 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 |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
SOD BICARB 4% 5ML VIAL
|
Facility
OP
|
$11.52
|
|
| Hospital Charge Code |
41646492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.76
|
| Rate for Payer: Aetna Government |
$5.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.83
|
| Rate for Payer: Group Health Inc Commercial |
$5.76
|
| Rate for Payer: Group Health Inc Medicare |
$4.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.49
|
|
|
SOD BICARB 4% 5ML VIAL
|
Facility
OP
|
$11.52
|
|
| Hospital Charge Code |
41656492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$9.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.76
|
| Rate for Payer: Aetna Government |
$5.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.83
|
| Rate for Payer: Group Health Inc Commercial |
$5.76
|
| Rate for Payer: Group Health Inc Medicare |
$4.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.49
|
|
|
SOD CHLORIDE 7% 4ML INH
|
Facility
OP
|
$0.42
|
|
| Hospital Charge Code |
41648438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
SOD CHLORIDE 7% 4ML INH
|
Facility
OP
|
$0.42
|
|
| Hospital Charge Code |
41658438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.29
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
SOD HYALURONATE 23MG/ML 0.6ML
|
Facility
OP
|
$127.50
|
|
| Hospital Charge Code |
41659549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.62 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.75
|
| Rate for Payer: Aetna Government |
$63.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$102.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86.70
|
| Rate for Payer: Group Health Inc Commercial |
$63.75
|
| Rate for Payer: Group Health Inc Medicare |
$44.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.88
|
|
|
SOD HYALURONATE 23MG/ML 0.6ML
|
Facility
OP
|
$127.50
|
|
| Hospital Charge Code |
41649549
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.62 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.75
|
| Rate for Payer: Aetna Government |
$63.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$102.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86.70
|
| Rate for Payer: Group Health Inc Commercial |
$63.75
|
| Rate for Payer: Group Health Inc Medicare |
$44.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$82.88
|
|
|
SOD HYPOCHLORITE 0.125% TOP SOLN
|
Facility
OP
|
$18.00
|
|
| Hospital Charge Code |
41655977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.00
|
| Rate for Payer: Aetna Government |
$9.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.24
|
| Rate for Payer: Group Health Inc Commercial |
$9.00
|
| Rate for Payer: Group Health Inc Medicare |
$6.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.70
|
|
|
SOD HYPOCHLORITE 0.125% TOP SOLN
|
Facility
OP
|
$18.00
|
|
| Hospital Charge Code |
41645977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.00
|
| Rate for Payer: Aetna Government |
$9.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.24
|
| Rate for Payer: Group Health Inc Commercial |
$9.00
|
| Rate for Payer: Group Health Inc Medicare |
$6.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.70
|
|
|
SODIUM
|
Facility
OP
|
$12.03
|
|
|
Service Code
|
HCPCS 84295
|
| Hospital Charge Code |
40602060
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$7.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.81
|
| Rate for Payer: Aetna Government |
$4.81
|
| Rate for Payer: Cash Price |
$4.81
|
| Rate for Payer: Cash Price |
$4.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.81
|
| Rate for Payer: EmblemHealth Commercial |
$4.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.28
|
| Rate for Payer: Group Health Inc Commercial |
$4.81
|
| Rate for Payer: Group Health Inc Medicare |
$4.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.81
|
| Rate for Payer: Healthfirst QHP |
$4.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.85
|
| Rate for Payer: Wellcare Medicare |
$4.33
|
|
|
SODIUM 24 HOUR URINE
|
Facility
OP
|
$12.65
|
|
|
Service Code
|
HCPCS 84300
|
| Hospital Charge Code |
40602625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.06
|
| Rate for Payer: Aetna Government |
$5.06
|
| Rate for Payer: Cash Price |
$5.06
|
| Rate for Payer: Cash Price |
$5.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.06
|
| Rate for Payer: EmblemHealth Commercial |
$5.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.50
|
| Rate for Payer: Group Health Inc Commercial |
$5.06
|
| Rate for Payer: Group Health Inc Medicare |
$5.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.06
|
| Rate for Payer: Healthfirst QHP |
$5.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.05
|
| Rate for Payer: Wellcare Medicare |
$4.55
|
|
|
SODIUM ACETATE 2 MEQ/ML INJ
|
Facility
OP
|
$1.20
|
|
| Hospital Charge Code |
41653926
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
SODIUM ACETATE 2 MEQ/ML INJ
|
Facility
OP
|
$1.20
|
|
| Hospital Charge Code |
41643926
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.60
|
| Rate for Payer: Aetna Government |
$0.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
SODIUM BICARBONATE 4.2% INJ 5 ML
|
Facility
OP
|
$4.02
|
|
| Hospital Charge Code |
41644268
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.01
|
| Rate for Payer: Aetna Government |
$2.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.73
|
| Rate for Payer: Group Health Inc Commercial |
$2.01
|
| Rate for Payer: Group Health Inc Medicare |
$1.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.61
|
|
