|
ASPIRIN 81 MG PO TBEC [688]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 16103035611
|
| Hospital Charge Code |
16103035611
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
ASPIRIN 81 MG PO TBEC [688]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 00904675180
|
| Hospital Charge Code |
00904675180
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.00
|
| Rate for Payer: Aetna Government |
$0.00
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
ASPIRIN 81 MG PO TBEC [688]
|
Facility
|
OP
|
$0.06
|
|
|
Service Code
|
NDC 63739021202
|
| Hospital Charge Code |
63739021202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Brighton Health Commercial |
$0.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.04
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.04
|
|
|
ASPIRIN 81 MG PO TBEC [688]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 69618006610
|
| Hospital Charge Code |
69618006610
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.00
|
| Rate for Payer: Aetna Government |
$0.00
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
ASPIRIN 81 MG PO TBEC [688]
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
NDC 49483048110
|
| Hospital Charge Code |
49483048110
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.00
|
| Rate for Payer: Aetna Government |
$0.00
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
ASPIRIN 81 MG PO TBEC [688]
|
Facility
|
OP
|
$0.02
|
|
|
Service Code
|
NDC 57896098101
|
| Hospital Charge Code |
57896098101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
ASPIRIN + DIPYRIDAMOLE 25 MG-200 MG CAP
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
41652640
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
ASPIRIN + DIPYRIDAMOLE 25 MG-200 MG CAP
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
41642640
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12 [27644]
|
Facility
|
OP
|
$8.36
|
|
|
Service Code
|
NDC 68462040560
|
| Hospital Charge Code |
68462040560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.18
|
| Rate for Payer: Aetna Government |
$4.18
|
| Rate for Payer: Brighton Health Commercial |
$6.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.68
|
| Rate for Payer: Group Health Inc Commercial |
$4.18
|
| Rate for Payer: Group Health Inc Medicare |
$2.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.43
|
|
|
ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12 [27644]
|
Facility
|
OP
|
$8.36
|
|
|
Service Code
|
NDC 65162059606
|
| Hospital Charge Code |
65162059606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.18
|
| Rate for Payer: Aetna Government |
$4.18
|
| Rate for Payer: Brighton Health Commercial |
$6.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.68
|
| Rate for Payer: Group Health Inc Commercial |
$4.18
|
| Rate for Payer: Group Health Inc Medicare |
$2.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.43
|
|
|
ASP OF BLADDER WITH CATH INSERT
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
30105796
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$2,355.42
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,355.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
ASP OF BLADDER WITH CATH INSERT
|
Facility
|
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
30305796
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,648.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,648.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,648.79
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$2,355.42
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Humana Medicare |
$2,402.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,355.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
ASP OF BLADDER WITH CATH INSERT
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
30105796
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
ASP OF BLADDER WITH CATH INSERT
|
Facility
|
IP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 51102
|
| Hospital Charge Code |
30305796
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$2,355.42
|
|
|
ASSAY ALKALINE PHOSPHATASES
|
Facility
|
OP
|
$36.95
|
|
|
Service Code
|
HCPCS 84080
|
| Hospital Charge Code |
40609605
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$27.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.78
|
| Rate for Payer: Aetna Government |
$14.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.35
|
| Rate for Payer: Brighton Health Commercial |
$27.71
|
| Rate for Payer: Cash Price |
$14.78
|
| Rate for Payer: Cash Price |
$14.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.78
|
| Rate for Payer: EmblemHealth Commercial |
$14.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.15
|
| Rate for Payer: Group Health Inc Commercial |
$14.78
|
| Rate for Payer: Group Health Inc Medicare |
$14.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.78
|
| Rate for Payer: Healthfirst QHP |
$14.78
|
| Rate for Payer: Humana Medicare |
$15.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.78
|
| Rate for Payer: United Healthcare Commercial |
$18.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.82
|
| Rate for Payer: Wellcare Medicare |
$13.30
|
|
|
ASSAY ALKALINE PHOSPHATASES
|
Facility
|
IP
|
$36.95
|
|
|
Service Code
|
HCPCS 84080
|
| Hospital Charge Code |
40609605
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$14.78
|
|
|
ASSAY OF APOLIPOPROTEIN
|
Facility
|
OP
|
$52.78
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
40729625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$39.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.09
|
| Rate for Payer: Aetna Government |
$21.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$14.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$14.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$14.76
|
| Rate for Payer: Brighton Health Commercial |
$39.58
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$21.09
|
| Rate for Payer: EmblemHealth Commercial |
$21.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$21.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.77
|
| Rate for Payer: Group Health Inc Commercial |
$21.09
|
| Rate for Payer: Group Health Inc Medicare |
$21.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21.09
|
| Rate for Payer: Healthfirst QHP |
$21.09
|
| Rate for Payer: Humana Medicare |
$21.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21.09
|
| Rate for Payer: United Healthcare Commercial |
$19.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.87
|
| Rate for Payer: Wellcare Medicare |
$18.98
|
|
|
ASSAY OF APOLIPOPROTEIN
|
Facility
|
IP
|
$52.78
|
|
|
Service Code
|
HCPCS 82172
|
| Hospital Charge Code |
40729625
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$21.09
|
|
|
ASSAY OF SWEAT SODIUM
|
Facility
|
IP
|
$12.15
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
40609607
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$4.86
|
|
|
ASSAY OF SWEAT SODIUM
|
Facility
|
OP
|
$12.15
|
|
|
Service Code
|
HCPCS 84302
|
| Hospital Charge Code |
40609607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$9.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.86
|
| Rate for Payer: Aetna Government |
$4.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.40
|
| Rate for Payer: Brighton Health Commercial |
$9.11
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Cash Price |
$4.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.86
|
| 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 |
$4.86
|
| Rate for Payer: EmblemHealth Commercial |
$4.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.33
|
| Rate for Payer: Group Health Inc Commercial |
$4.86
|
| Rate for Payer: Group Health Inc Medicare |
$4.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.86
|
| Rate for Payer: Healthfirst QHP |
$4.86
|
| Rate for Payer: Humana Medicare |
$4.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.86
|
| Rate for Payer: United Healthcare Commercial |
$6.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.89
|
| Rate for Payer: Wellcare Medicare |
$4.37
|
|
|
ASSAY OF TOTAL ESTRADIOL
|
Facility
|
IP
|
$69.85
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
40609069
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$27.94
|
|
|
ASSAY OF TOTAL ESTRADIOL
|
Facility
|
OP
|
$69.85
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
40609069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.56 |
| Max. Negotiated Rate |
$52.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.94
|
| Rate for Payer: Aetna Government |
$27.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19.56
|
| Rate for Payer: Brighton Health Commercial |
$52.39
|
| Rate for Payer: Cash Price |
$27.94
|
| Rate for Payer: Cash Price |
$27.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.94
|
| Rate for Payer: EmblemHealth Commercial |
$27.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.87
|
| Rate for Payer: Group Health Inc Commercial |
$27.94
|
| Rate for Payer: Group Health Inc Medicare |
$27.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.94
|
| Rate for Payer: Healthfirst QHP |
$27.94
|
| Rate for Payer: Humana Medicare |
$28.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.94
|
| Rate for Payer: United Healthcare Commercial |
$35.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.35
|
| Rate for Payer: Wellcare Medicare |
$25.15
|
|
|
ASSAY OF TOTL ESTRADIOL
|
Facility
|
IP
|
$69.85
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
40609068
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$27.94
|
|
|
ASSAY OF TOTL ESTRADIOL
|
Facility
|
OP
|
$69.85
|
|
|
Service Code
|
HCPCS 82670
|
| Hospital Charge Code |
40609068
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.56 |
| Max. Negotiated Rate |
$52.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.94
|
| Rate for Payer: Aetna Government |
$27.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19.56
|
| Rate for Payer: Brighton Health Commercial |
$52.39
|
| Rate for Payer: Cash Price |
$27.94
|
| Rate for Payer: Cash Price |
$27.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.94
|
| Rate for Payer: EmblemHealth Commercial |
$27.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.87
|
| Rate for Payer: Group Health Inc Commercial |
$27.94
|
| Rate for Payer: Group Health Inc Medicare |
$27.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.94
|
| Rate for Payer: Healthfirst QHP |
$27.94
|
| Rate for Payer: Humana Medicare |
$28.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.94
|
| Rate for Payer: United Healthcare Commercial |
$35.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.35
|
| Rate for Payer: Wellcare Medicare |
$25.15
|
|
|
ASSAY OTHER FLUID CHLORIDES
|
Facility
|
OP
|
$12.50
|
|
|
Service Code
|
HCPCS 82438
|
| Hospital Charge Code |
40609608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$9.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.50
|
| Rate for Payer: Brighton Health Commercial |
$9.38
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.00
|
| Rate for Payer: EmblemHealth Commercial |
$5.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.45
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.00
|
| Rate for Payer: Healthfirst QHP |
$5.00
|
| Rate for Payer: Humana Medicare |
$5.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.00
|
| Rate for Payer: United Healthcare Commercial |
$6.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.00
|
| Rate for Payer: Wellcare Medicare |
$4.50
|
|
