|
TERUMO GUIDE WIRE .035X150CM
|
Facility
IP
|
$61.40
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40205598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.70 |
| Max. Negotiated Rate |
$30.70 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.70
|
|
|
TERUMO PINNACLE INTO SHEATH
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
40206283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.82
|
| Rate for Payer: Aetna Government |
$0.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.95
|
| Rate for Payer: Group Health Inc Commercial |
$9.50
|
| Rate for Payer: Group Health Inc Medicare |
$6.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.35
|
|
|
TERUMO PINNACLE INTO SHEATH
|
Facility
IP
|
$19.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
40206283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.50
|
|
|
TERUMO RF GILDECATH COBRA 4FR
|
Facility
IP
|
$103.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
40208127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$51.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.75
|
|
|
TERUMO RF GILDECATH COBRA 4FR
|
Facility
OP
|
$103.50
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
40208127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$108.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.21
|
| Rate for Payer: Aetna Government |
$3.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$108.68
|
| Rate for Payer: Group Health Inc Commercial |
$51.75
|
| Rate for Payer: Group Health Inc Medicare |
$36.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$67.28
|
|
|
TEST CHECK STREP A BD
|
Facility
OP
|
$113.28
|
|
| Hospital Charge Code |
64903271
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$39.65 |
| Max. Negotiated Rate |
$90.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.64
|
| Rate for Payer: Aetna Government |
$56.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.03
|
| Rate for Payer: Group Health Inc Commercial |
$56.64
|
| Rate for Payer: Group Health Inc Medicare |
$39.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.64
|
|
|
TESTES PROCEDURES WITH CC/MCC
|
Facility
IP
|
$37,502.27
|
|
|
Service Code
|
MS-DRG 711
|
| Min. Negotiated Rate |
$17,096.62 |
| Max. Negotiated Rate |
$37,502.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31,302.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36,766.93
|
| Rate for Payer: Aetna Government |
$36,766.93
|
| Rate for Payer: Brighton Health Commercial |
$30,782.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37,502.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36,660.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30,253.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$34,928.58
|
| Rate for Payer: EmblemHealth Commercial |
$18,203.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$36,766.93
|
| Rate for Payer: Group Health Inc Commercial |
$36,766.93
|
| Rate for Payer: Group Health Inc Medicare |
$36,766.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36,766.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,096.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36,766.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36,766.93
|
| Rate for Payer: Wellcare Medicare |
$34,928.58
|
|
|
TESTES PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$24,284.00
|
|
|
Service Code
|
MS-DRG 712
|
| Min. Negotiated Rate |
$10,190.50 |
| Max. Negotiated Rate |
$24,284.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,522.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,807.84
|
| Rate for Payer: Aetna Government |
$23,807.84
|
| Rate for Payer: Brighton Health Commercial |
$17,231.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,284.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,522.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,936.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,617.45
|
| Rate for Payer: EmblemHealth Commercial |
$10,190.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,807.84
|
| Rate for Payer: Group Health Inc Commercial |
$23,807.84
|
| Rate for Payer: Group Health Inc Medicare |
$23,807.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,807.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,070.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,807.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,807.84
|
| Rate for Payer: Wellcare Medicare |
$22,617.45
|
|
|
TESTICULAR PROSTHESIS
|
Facility
IP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
40205193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.00 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,750.00
|
|
|
TESTICULAR PROSTHESIS
|
Facility
OP
|
$3,500.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
40205193
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,225.00 |
| Max. Negotiated Rate |
$3,775.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,925.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,750.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,012.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,675.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,750.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,750.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,275.00
|
|
|
TESTICULAR PROSTHESIS 2.7 X 4
|
Facility
OP
|
$4,775.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64903962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,671.25 |
| Max. Negotiated Rate |
$5,013.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,626.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,387.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,745.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,013.75
|
| Rate for Payer: Group Health Inc Commercial |
$2,387.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,671.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,387.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,387.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,103.75
|
|
|
TESTICULAR PROSTHESIS 2.7 X 4
|
Facility
IP
|
$4,775.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64903962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,387.50 |
| Max. Negotiated Rate |
$2,387.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,387.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,387.50
|
|
|
TESTOSTERINE, FREE+WEAKLY BOUND
|
Facility
OP
|
$63.68
|
|
|
Service Code
|
HCPCS 84402
|
| Hospital Charge Code |
40609118
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.47
|
| Rate for Payer: Aetna Government |
$25.47
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.47
|
| Rate for Payer: EmblemHealth Commercial |
$25.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.67
|
| Rate for Payer: Group Health Inc Commercial |
$25.47
|
| Rate for Payer: Group Health Inc Medicare |
$25.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.47
|
| Rate for Payer: Healthfirst QHP |
$25.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.38
|
| Rate for Payer: Wellcare Medicare |
$22.92
|
|
|
TESTOSTERONE 2.5 MG/24 HR PATCH
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
41655401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.50
|
| Rate for Payer: Aetna Government |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.12
|
| Rate for Payer: Group Health Inc Commercial |
$4.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.85
|
|
|
TESTOSTERONE 2.5 MG/24 HR PATCH
|
Facility
OP
|
$9.00
|
|
| Hospital Charge Code |
41645401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.50
|
| Rate for Payer: Aetna Government |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.12
|
| Rate for Payer: Group Health Inc Commercial |
$4.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.85
|
|
|
TESTOSTERONE, FREE+TOTAL LC/MS
|
Facility
OP
|
$63.68
|
|
|
Service Code
|
HCPCS 84402
|
| Hospital Charge Code |
40609119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.47
|
| Rate for Payer: Aetna Government |
$25.47
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.47
|
| Rate for Payer: EmblemHealth Commercial |
$25.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.67
|
| Rate for Payer: Group Health Inc Commercial |
$25.47
|
| Rate for Payer: Group Health Inc Medicare |
$25.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.47
|
| Rate for Payer: Healthfirst QHP |
$25.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.38
|
| Rate for Payer: Wellcare Medicare |
$22.92
|
|
|
TESTOSTERONE, TOTAL, LC/MS
|
Facility
OP
|
$64.53
|
|
|
Service Code
|
HCPCS 84403
|
| Hospital Charge Code |
40609120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$41.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.81
|
| Rate for Payer: Aetna Government |
$25.81
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.81
|
| Rate for Payer: EmblemHealth Commercial |
$25.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.97
|
| Rate for Payer: Group Health Inc Commercial |
$25.81
|
| Rate for Payer: Group Health Inc Medicare |
$25.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.81
|
| Rate for Payer: Healthfirst QHP |
$25.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.65
|
| Rate for Payer: Wellcare Medicare |
$23.23
|
|
|
TESTOSTERONE, TOT, LC/MS/MS
|
Facility
OP
|
$64.53
|
|
|
Service Code
|
HCPCS 84403
|
| Hospital Charge Code |
40608436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.65 |
| Max. Negotiated Rate |
$41.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.81
|
| Rate for Payer: Aetna Government |
$25.81
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.81
|
| Rate for Payer: EmblemHealth Commercial |
$25.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.97
|
| Rate for Payer: Group Health Inc Commercial |
$25.81
|
| Rate for Payer: Group Health Inc Medicare |
$25.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.81
|
| Rate for Payer: Healthfirst QHP |
$25.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.65
|
| Rate for Payer: Wellcare Medicare |
$23.23
|
|
|
TEST PREGNANCY ICON 25 COMBO HCG
|
Facility
OP
|
$2.12
|
|
| Hospital Charge Code |
64901074
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.06
|
| Rate for Payer: Aetna Government |
$1.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.44
|
| Rate for Payer: Group Health Inc Commercial |
$1.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.06
|
|
|
TEST TO ANALYZE CORNEA SHAPE
|
Facility
OP
|
$172.39
|
|
|
Service Code
|
HCPCS 92025
|
| Hospital Charge Code |
30302055
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.74
|
| Rate for Payer: Aetna Government |
$70.74
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Cash Price |
$70.74
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$70.74
|
| 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 |
$70.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$60.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$62.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$70.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62.96
|
| 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 |
$86.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$60.13
|
| Rate for Payer: Healthfirst QHP |
$70.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$70.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$70.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$70.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$56.59
|
| Rate for Payer: Wellcare Medicare |
$67.20
|
|
|
TETANUS ANTITOXOID IGG AB
|
Facility
OP
|
$37.48
|
|
|
Service Code
|
HCPCS 86317
|
| Hospital Charge Code |
40729339
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$23.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.99
|
| Rate for Payer: Aetna Government |
$14.99
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.99
|
| Rate for Payer: EmblemHealth Commercial |
$14.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.34
|
| Rate for Payer: Group Health Inc Commercial |
$14.99
|
| Rate for Payer: Group Health Inc Medicare |
$14.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.99
|
| Rate for Payer: Healthfirst QHP |
$14.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.99
|
| Rate for Payer: Wellcare Medicare |
$13.49
|
|
|
TETANUS IG IM
|
Facility
OP
|
$107.64
|
|
|
Service Code
|
HCPCS 90389
|
| Hospital Charge Code |
30105773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$595.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$595.90
|
| Rate for Payer: Aetna Government |
$595.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$86.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$73.20
|
| Rate for Payer: Group Health Inc Commercial |
$53.82
|
| Rate for Payer: Group Health Inc Medicare |
$37.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.97
|
|
|
TETANUS IMMUNE GLOBULIN 250 UNITS INJ
|
Facility
IP
|
$650.12
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
41644396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$325.06 |
| Max. Negotiated Rate |
$325.06 |
| Rate for Payer: Cash Price |
$578.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.06
|
|
|
TETANUS IMMUNE GLOBULIN 250 UNITS INJ
|
Facility
IP
|
$650.12
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
41654396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$325.06 |
| Max. Negotiated Rate |
$325.06 |
| Rate for Payer: Cash Price |
$578.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.06
|
|
|
TETANUS IMMUNE GLOBULIN 250 UNITS INJ
|
Facility
OP
|
$650.12
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
41644396
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$325.06 |
| Max. Negotiated Rate |
$613.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$357.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$578.61
|
| Rate for Payer: Aetna Government |
$578.61
|
| Rate for Payer: Cash Price |
$578.61
|
| Rate for Payer: Cash Price |
$578.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$578.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$325.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$373.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$578.61
|
| Rate for Payer: EmblemHealth Commercial |
$578.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$578.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$578.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$607.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$578.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$607.54
|
| Rate for Payer: Group Health Inc Commercial |
$578.61
|
| Rate for Payer: Group Health Inc Medicare |
$578.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$540.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$491.82
|
| Rate for Payer: Healthfirst QHP |
$578.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$578.61
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$613.51
|
| Rate for Payer: SOMOS Essential |
$613.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$422.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$462.89
|
| Rate for Payer: Wellcare Medicare |
$549.68
|
|
