|
Z CATH COBRA 3 5FR 035-65 CM
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41569732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$58.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$58.80
|
| Rate for Payer: Group Health Inc Commercial |
$28.00
|
| Rate for Payer: Group Health Inc Medicare |
$19.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.40
|
|
|
ZENITH FLEX GRAFT MAIN BODY
|
Facility
OP
|
$21,780.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
64904951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.77 |
| Max. Negotiated Rate |
$22,869.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,979.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$322.77
|
| Rate for Payer: Aetna Government |
$322.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10,890.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,523.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,869.00
|
| Rate for Payer: Group Health Inc Commercial |
$10,890.00
|
| Rate for Payer: Group Health Inc Medicare |
$7,623.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10,890.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10,890.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,157.00
|
|
|
ZENITH FLEX GRAFT MAIN BODY
|
Facility
IP
|
$21,780.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
64904951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,890.00 |
| Max. Negotiated Rate |
$10,890.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10,890.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10,890.00
|
|
|
ZENITH SPIRAL Z ILC LEG GRAFT A
|
Facility
OP
|
$7,945.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
64906039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.77 |
| Max. Negotiated Rate |
$8,342.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,369.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$322.77
|
| Rate for Payer: Aetna Government |
$322.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,972.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,568.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,342.25
|
| Rate for Payer: Group Health Inc Commercial |
$3,972.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,780.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,972.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,972.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,164.25
|
|
|
ZENITH SPIRAL Z ILC LEG GRAFT A
|
Facility
IP
|
$7,945.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
64906039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,972.50 |
| Max. Negotiated Rate |
$3,972.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,972.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,972.50
|
|
|
ZENITH SPIRAL Z ILC LEG GRAFT B
|
Facility
IP
|
$7,945.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
64906040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,972.50 |
| Max. Negotiated Rate |
$3,972.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,972.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,972.50
|
|
|
ZENITH SPIRAL Z ILC LEG GRAFT B
|
Facility
OP
|
$7,945.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
64906040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.77 |
| Max. Negotiated Rate |
$8,342.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,369.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$322.77
|
| Rate for Payer: Aetna Government |
$322.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,972.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,568.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,342.25
|
| Rate for Payer: Group Health Inc Commercial |
$3,972.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,780.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,972.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,972.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5,164.25
|
|
|
ZEPHEROR
|
Facility
OP
|
$6.73
|
|
| Hospital Charge Code |
40207590
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$5.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.36
|
| Rate for Payer: Aetna Government |
$3.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.58
|
| Rate for Payer: Group Health Inc Commercial |
$3.36
|
| Rate for Payer: Group Health Inc Medicare |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.36
|
|
|
Zeroform Dressing
|
Facility
OP
|
$4.25
|
|
| Hospital Charge Code |
40207500
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.12
|
| Rate for Payer: Aetna Government |
$2.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.89
|
| Rate for Payer: Group Health Inc Commercial |
$2.12
|
| Rate for Payer: Group Health Inc Medicare |
$1.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.12
|
|
|
ZICKEL NAIL
|
Facility
OP
|
$360.76
|
|
| Hospital Charge Code |
40207024
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$126.27 |
| Max. Negotiated Rate |
$288.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$198.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.38
|
| Rate for Payer: Aetna Government |
$180.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$288.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$245.32
|
| Rate for Payer: Group Health Inc Commercial |
$180.38
|
| Rate for Payer: Group Health Inc Medicare |
$126.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$180.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.38
|
|
|
ZICKEL ROD
|
Facility
OP
|
$1,713.76
|
|
| Hospital Charge Code |
40207023
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$599.82 |
| Max. Negotiated Rate |
$1,371.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$942.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$856.88
|
| Rate for Payer: Aetna Government |
$856.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,371.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,165.36
|
| Rate for Payer: Group Health Inc Commercial |
$856.88
|
| Rate for Payer: Group Health Inc Medicare |
$599.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$856.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$856.88
|
|
|
ZICKEL SCREW
|
Facility
OP
|
$258.70
|
|
| Hospital Charge Code |
40207025
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.54 |
| Max. Negotiated Rate |
$206.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$142.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.35
|
| Rate for Payer: Aetna Government |
$129.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.92
|
| Rate for Payer: Group Health Inc Commercial |
$129.35
|
| Rate for Payer: Group Health Inc Medicare |
$90.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.35
|
|
|
ZIDOVUDINE 100 MG CAP
|
Facility
OP
|
$2.50
|
|
| Hospital Charge Code |
41641805
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.25
|
| Rate for Payer: Aetna Government |
$1.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.62
|
|
|
ZIDOVUDINE 100 MG CAP
|
Facility
OP
|
$2.50
|
|
| Hospital Charge Code |
41651805
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.25
|
| Rate for Payer: Aetna Government |
$1.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.70
|
| Rate for Payer: Group Health Inc Commercial |
$1.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.62
|
|
|
ZIDOVUDINE 10 MG/ML INJ
|
Facility
OP
|
$2.89
|
|
|
Service Code
|
HCPCS J3485
|
| Hospital Charge Code |
41651806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.51
|
| Rate for Payer: Aetna Government |
$1.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.44
|
| Rate for Payer: Group Health Inc Medicare |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.60
|
| Rate for Payer: SOMOS Essential |
$1.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.88
|
|
|
ZIDOVUDINE 10 MG/ML INJ
|
Facility
IP
|
$2.89
|
|
|
Service Code
|
HCPCS J3485
|
| Hospital Charge Code |
41641806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.44
|
|
|
ZIDOVUDINE 10 MG/ML INJ
|
Facility
OP
|
$2.89
|
|
|
Service Code
|
HCPCS J3485
|
| Hospital Charge Code |
41641806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.51
|
| Rate for Payer: Aetna Government |
$1.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.44
|
| Rate for Payer: Group Health Inc Medicare |
$1.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.51
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.60
|
| Rate for Payer: SOMOS Essential |
$1.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.88
|
|
|
ZIDOVUDINE 10 MG/ML INJ
|
Facility
IP
|
$2.89
|
|
|
Service Code
|
HCPCS J3485
|
| Hospital Charge Code |
41651806
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.44
|
|
|
ZIDOVUDINE 10MG/ML SYRUP
|
Facility
OP
|
$0.30
|
|
| Hospital Charge Code |
41651807
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
ZIDOVUDINE 10MG/ML SYRUP
|
Facility
OP
|
$0.30
|
|
| Hospital Charge Code |
41641807
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
ZIDOVUDINE 300 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41641812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ZIDOVUDINE 300 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41651812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ZIDOVUDINE 4 MG/ML INJ PEDIATRIC
|
Facility
OP
|
$53.00
|
|
| Hospital Charge Code |
41643660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.55 |
| Max. Negotiated Rate |
$42.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.50
|
| Rate for Payer: Aetna Government |
$26.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.04
|
| Rate for Payer: Group Health Inc Commercial |
$26.50
|
| Rate for Payer: Group Health Inc Medicare |
$18.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.45
|
|
|
ZIDOVUDINE 4 MG/ML INJ PEDIATRIC
|
Facility
OP
|
$53.00
|
|
| Hospital Charge Code |
41653660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.55 |
| Max. Negotiated Rate |
$42.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.50
|
| Rate for Payer: Aetna Government |
$26.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.04
|
| Rate for Payer: Group Health Inc Commercial |
$26.50
|
| Rate for Payer: Group Health Inc Medicare |
$18.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.45
|
|
|
ZIDOVUDINE + LAMIVUDINE 150 MG - 300 MG
|
Facility
OP
|
$28.00
|
|
| Hospital Charge Code |
41642197
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.00
|
| Rate for Payer: Aetna Government |
$14.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.04
|
| Rate for Payer: Group Health Inc Commercial |
$14.00
|
| Rate for Payer: Group Health Inc Medicare |
$9.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.20
|
|
