|
RX CL ELBOW DISLOC W/O ANESTHESIA
|
Facility
|
IP
|
$653.13
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
30103304
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$272.71
|
|
|
RX CONTACT LENS APHKIA 2 EYE
|
Facility
|
IP
|
$166.60
|
|
|
Service Code
|
HCPCS 92316
|
| Hospital Charge Code |
30306403
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
RX CONTACT LENS APHKIA 2 EYE
|
Facility
|
OP
|
$166.60
|
|
|
Service Code
|
HCPCS 92316
|
| Hospital Charge Code |
30306403
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| 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 |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$83.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
RX STANDARD ERCP CANNULA
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
|
|
RX STANDARD ERCP CANNULA
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209676
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$339.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$92.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$77.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.55
|
| Rate for Payer: EmblemHealth Commercial |
$77.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$161.70
|
| Rate for Payer: Group Health Inc Commercial |
$77.00
|
| Rate for Payer: Group Health Inc Medicare |
$53.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.10
|
|
|
RX TAPERED ERCP CANNULA
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
40200897
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$123.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77.00
|
| Rate for Payer: Aetna Government |
$77.00
|
| Rate for Payer: Brighton Health Commercial |
$115.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$123.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$104.72
|
| Rate for Payer: Group Health Inc Commercial |
$77.00
|
| Rate for Payer: Group Health Inc Medicare |
$53.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
|
|
S7845 AUTOCHECK 6< LEVEL 2
|
Facility
|
OP
|
$8.32
|
|
| Hospital Charge Code |
64903515
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$6.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.16
|
| Rate for Payer: Aetna Government |
$4.16
|
| Rate for Payer: Brighton Health Commercial |
$6.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.66
|
| Rate for Payer: Group Health Inc Commercial |
$4.16
|
| Rate for Payer: Group Health Inc Medicare |
$2.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.16
|
|
|
SACCHAROMYCES BOULARDII 250 MG CAP - NF
|
Facility
|
OP
|
$1.38
|
|
| Hospital Charge Code |
41643773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna Government |
$0.69
|
| Rate for Payer: Brighton Health Commercial |
$1.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.94
|
| Rate for Payer: Group Health Inc Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Medicare |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.90
|
|
|
SACCHAROMYCES BOULARDII 250 MG CAP - NF
|
Facility
|
OP
|
$1.38
|
|
| Hospital Charge Code |
41653773
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna Government |
$0.69
|
| Rate for Payer: Brighton Health Commercial |
$1.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.94
|
| Rate for Payer: Group Health Inc Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Medicare |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.90
|
|
|
SACCHAROMYCES CEREVISIAE PANEL
|
Facility
|
OP
|
$30.63
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
40729363
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.25
|
| Rate for Payer: Aetna Government |
$12.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.58
|
| Rate for Payer: Brighton Health Commercial |
$22.97
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: Cash Price |
$12.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.25
|
| Rate for Payer: EmblemHealth Commercial |
$12.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.90
|
| Rate for Payer: Group Health Inc Commercial |
$12.25
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.25
|
| Rate for Payer: Healthfirst QHP |
$12.25
|
| Rate for Payer: Humana Medicare |
$12.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.25
|
| Rate for Payer: United Healthcare Commercial |
$15.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.80
|
| Rate for Payer: Wellcare Medicare |
$11.02
|
|
|
SACCHAROMYCES CEREVISIAE PANEL
|
Facility
|
IP
|
$30.63
|
|
|
Service Code
|
HCPCS 86671
|
| Hospital Charge Code |
40729363
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$12.25
|
|
|
SACITUZUMAB GOVITECAN-HZIY
|
Facility
|
OP
|
$64.47
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
41640242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$41.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.08
|
| Rate for Payer: Aetna Government |
$34.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$23.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23.85
|
| Rate for Payer: Brighton Health Commercial |
$38.68
|
| Rate for Payer: Cash Price |
$34.08
|
| Rate for Payer: Cash Price |
$34.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.08
|
| Rate for Payer: EmblemHealth Commercial |
$34.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.78
|
| Rate for Payer: Group Health Inc Commercial |
$34.08
|
| Rate for Payer: Group Health Inc Medicare |
$34.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.97
|
| Rate for Payer: Healthfirst QHP |
$34.08
|
| Rate for Payer: Humana Medicare |
$34.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.15
|
| Rate for Payer: SOMOS Essential |
$36.15
|
| Rate for Payer: United Healthcare Commercial |
$32.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.26
|
| Rate for Payer: Wellcare Medicare |
$32.37
|
|
|
SACITUZUMAB GOVITECAN-HZIY
|
Facility
|
IP
|
$64.47
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
41650242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$32.24 |
| Rate for Payer: Cash Price |
$34.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.24
|
|
|
SACITUZUMAB GOVITECAN-HZIY
|
Facility
|
OP
|
$64.47
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
41650242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$41.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.08
|
| Rate for Payer: Aetna Government |
$34.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$23.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23.85
|
| Rate for Payer: Brighton Health Commercial |
$38.68
|
| Rate for Payer: Cash Price |
$34.08
|
| Rate for Payer: Cash Price |
$34.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.08
|
| Rate for Payer: EmblemHealth Commercial |
$34.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$34.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$35.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35.78
|
| Rate for Payer: Group Health Inc Commercial |
$34.08
|
| Rate for Payer: Group Health Inc Medicare |
$34.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.97
|
| Rate for Payer: Healthfirst QHP |
$34.08
|
| Rate for Payer: Humana Medicare |
$34.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$36.15
|
| Rate for Payer: SOMOS Essential |
$36.15
|
| Rate for Payer: United Healthcare Commercial |
$32.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$41.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.26
|
| Rate for Payer: Wellcare Medicare |
$32.37
|
|
|
SACITUZUMAB GOVITECAN-HZIY
|
Facility
|
IP
|
$64.47
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
41640242
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$32.24 |
| Rate for Payer: Cash Price |
$34.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.24
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG/18ML IV (WET SOLR VIAL) [430173279]
|
Facility
|
OP
|
$2,884.63
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
55135013201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$1,875.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,586.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.08
|
| Rate for Payer: Aetna Government |
$34.08
|
| Rate for Payer: Brighton Health Commercial |
$1,730.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,442.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,658.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,442.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.08
|
| Rate for Payer: Group Health Inc Commercial |
$34.08
|
| Rate for Payer: Group Health Inc Medicare |
$34.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,442.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,442.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.97
|
| Rate for Payer: Healthfirst QHP |
$34.08
|
| Rate for Payer: Humana Medicare |
$34.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,875.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.26
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG/18ML IV (WET SOLR VIAL) [430173279]
|
Facility
|
IP
|
$2,884.63
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
55135013201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.32 |
| Max. Negotiated Rate |
$1,442.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,442.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,442.32
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG IV SOLR [173279]
|
Facility
|
IP
|
$2,884.63
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
55135013201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.32 |
| Max. Negotiated Rate |
$1,442.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,442.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,442.32
|
|
|
SACITUZUMAB GOVITECAN-HZIY 180 MG IV SOLR [173279]
|
Facility
|
OP
|
$2,884.63
|
|
|
Service Code
|
HCPCS J9317
|
| Hospital Charge Code |
55135013201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$1,875.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,586.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34.08
|
| Rate for Payer: Aetna Government |
$34.08
|
| Rate for Payer: Brighton Health Commercial |
$1,730.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,442.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,658.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$34.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,442.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$34.08
|
| Rate for Payer: Group Health Inc Commercial |
$34.08
|
| Rate for Payer: Group Health Inc Medicare |
$34.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,442.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,442.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.97
|
| Rate for Payer: Healthfirst QHP |
$34.08
|
| Rate for Payer: Humana Medicare |
$34.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,875.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.26
|
|
|
SACKS-VINE GASTROSTOMY KIT
|
Facility
|
OP
|
$166.91
|
|
| Hospital Charge Code |
40202200
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$133.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.46
|
| Rate for Payer: Aetna Government |
$83.46
|
| Rate for Payer: Brighton Health Commercial |
$125.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.50
|
| Rate for Payer: Group Health Inc Commercial |
$83.46
|
| Rate for Payer: Group Health Inc Medicare |
$58.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.46
|
|
|
SACRAL LAMINECTOMY
|
Facility
|
OP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 63011
|
| Hospital Charge Code |
40000495
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$13,588.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,273.12
|
| Rate for Payer: Aetna Government |
$8,273.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,791.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,791.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5,791.18
|
| Rate for Payer: Brighton Health Commercial |
$13,588.37
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Cash Price |
$8,273.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,273.12
|
| 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 |
$8,273.12
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,032.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,363.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,273.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,363.08
|
| Rate for Payer: Group Health Inc Commercial |
$8,273.12
|
| Rate for Payer: Group Health Inc Medicare |
$8,273.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,058.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,273.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,032.15
|
| Rate for Payer: Healthfirst QHP |
$8,273.12
|
| Rate for Payer: Humana Medicare |
$8,438.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,273.12
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,273.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,273.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,618.50
|
| Rate for Payer: Wellcare Medicare |
$7,859.46
|
|
|
SACRAL LAMINECTOMY
|
Facility
|
IP
|
$18,117.83
|
|
|
Service Code
|
HCPCS 63011
|
| Hospital Charge Code |
40000495
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$8,273.12
|
|
|
SACUBITRIL-VALSARTAN 24-26 MG PO TABS [129911]
|
Facility
|
OP
|
$13.76
|
|
|
Service Code
|
NDC 00078065920
|
| Hospital Charge Code |
00078065920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$11.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Government |
$6.88
|
| Rate for Payer: Brighton Health Commercial |
$10.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.36
|
| Rate for Payer: Group Health Inc Commercial |
$6.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.94
|
|
|
SACUBITRIL/VALSARTAN 24MG-26MG
|
Facility
|
OP
|
$52.70
|
|
| Hospital Charge Code |
41640210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.35
|
| Rate for Payer: Aetna Government |
$26.35
|
| Rate for Payer: Brighton Health Commercial |
$39.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.84
|
| Rate for Payer: Group Health Inc Commercial |
$26.35
|
| Rate for Payer: Group Health Inc Medicare |
$18.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.26
|
|
|
SACUBITRIL/VALSARTAN 24MG-26MG
|
Facility
|
OP
|
$52.70
|
|
| Hospital Charge Code |
41650210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.35
|
| Rate for Payer: Aetna Government |
$26.35
|
| Rate for Payer: Brighton Health Commercial |
$39.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.84
|
| Rate for Payer: Group Health Inc Commercial |
$26.35
|
| Rate for Payer: Group Health Inc Medicare |
$18.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.26
|
|
