|
BELLADONNA ALKALOIDS + PHENOBARBITAL ELI
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41645252
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
BELLADONNA ALKALOIDS + PHENOBARBITAL ELI
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41655252
|
|
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: Brighton Health Commercial |
$0.75
|
| 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
|
|
|
BELLADONNA + PHENOBARBITAL TAB
|
Facility
|
OP
|
$0.09
|
|
| Hospital Charge Code |
41643396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
BELLADONNA + PHENOBARBITAL TAB
|
Facility
|
OP
|
$0.09
|
|
| Hospital Charge Code |
41653396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
BELOPAK
|
Facility
|
OP
|
$92.49
|
|
| Hospital Charge Code |
40200606
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$32.37 |
| Max. Negotiated Rate |
$73.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.24
|
| Rate for Payer: Aetna Government |
$46.24
|
| Rate for Payer: Brighton Health Commercial |
$69.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.89
|
| Rate for Payer: Group Health Inc Commercial |
$46.24
|
| Rate for Payer: Group Health Inc Medicare |
$32.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.24
|
|
|
BELT, OSTOMY
|
Facility
|
OP
|
$40.25
|
|
| Hospital Charge Code |
40201971
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.12
|
| Rate for Payer: Aetna Government |
$20.12
|
| Rate for Payer: Brighton Health Commercial |
$30.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.37
|
| Rate for Payer: Group Health Inc Commercial |
$20.12
|
| Rate for Payer: Group Health Inc Medicare |
$14.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.12
|
|
|
BELT, OSTOMY, LARGE, 34-65
|
Facility
|
OP
|
$40.25
|
|
| Hospital Charge Code |
64902146
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.12
|
| Rate for Payer: Aetna Government |
$20.12
|
| Rate for Payer: Brighton Health Commercial |
$30.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.37
|
| Rate for Payer: Group Health Inc Commercial |
$20.12
|
| Rate for Payer: Group Health Inc Medicare |
$14.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.12
|
|
|
BELT, OSTOMY, MEDIUM, 23-43
|
Facility
|
OP
|
$40.25
|
|
| Hospital Charge Code |
64902147
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.12
|
| Rate for Payer: Aetna Government |
$20.12
|
| Rate for Payer: Brighton Health Commercial |
$30.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.37
|
| Rate for Payer: Group Health Inc Commercial |
$20.12
|
| Rate for Payer: Group Health Inc Medicare |
$14.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.12
|
|
|
BENDAMUSTINE 100 MG INJ
|
Facility
|
OP
|
$27.60
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
41644984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.19
|
| Rate for Payer: Aetna Government |
$9.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.43
|
| Rate for Payer: Brighton Health Commercial |
$16.56
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.19
|
| Rate for Payer: EmblemHealth Commercial |
$9.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.65
|
| Rate for Payer: Group Health Inc Commercial |
$9.19
|
| Rate for Payer: Group Health Inc Medicare |
$9.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.81
|
| Rate for Payer: Healthfirst QHP |
$9.19
|
| Rate for Payer: Humana Medicare |
$9.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.86
|
| Rate for Payer: SOMOS Essential |
$8.86
|
| Rate for Payer: United Healthcare Commercial |
$14.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.35
|
| Rate for Payer: Wellcare Medicare |
$8.73
|
|
|
BENDAMUSTINE 100 MG INJ
|
Facility
|
OP
|
$27.60
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
41654984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$17.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.19
|
| Rate for Payer: Aetna Government |
$9.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.43
|
| Rate for Payer: Brighton Health Commercial |
$16.56
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.87
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.19
|
| Rate for Payer: EmblemHealth Commercial |
$9.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.65
|
| Rate for Payer: Group Health Inc Commercial |
$9.19
|
| Rate for Payer: Group Health Inc Medicare |
$9.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.81
|
| Rate for Payer: Healthfirst QHP |
$9.19
|
| Rate for Payer: Humana Medicare |
$9.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.86
|
| Rate for Payer: SOMOS Essential |
$8.86
|
| Rate for Payer: United Healthcare Commercial |
$14.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.35
|
| Rate for Payer: Wellcare Medicare |
$8.73
|
|
|
BENDAMUSTINE 100 MG INJ
|
Facility
|
IP
|
$27.60
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
41644984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$13.80 |
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.80
|
|
|
BENDAMUSTINE 100 MG INJ
|
Facility
|
IP
|
$27.60
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
41654984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$13.80 |
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.80
|
|
|
BENDAMUSTINE 180MG/2ML - 1MG
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
41656801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
|
|
BENDAMUSTINE 180MG/2ML - 1MG
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
41656801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.19
|
| Rate for Payer: Aetna Government |
$9.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.43
|
| Rate for Payer: Brighton Health Commercial |
$48.00
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.19
|
| Rate for Payer: EmblemHealth Commercial |
$9.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.65
|
| Rate for Payer: Group Health Inc Commercial |
$9.19
|
| Rate for Payer: Group Health Inc Medicare |
$9.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.81
|
| Rate for Payer: Healthfirst QHP |
$9.19
|
| Rate for Payer: Humana Medicare |
$9.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.86
|
| Rate for Payer: SOMOS Essential |
$8.86
|
| Rate for Payer: United Healthcare Commercial |
$14.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.35
|
| Rate for Payer: Wellcare Medicare |
$8.73
|
|
|
BENDAMUSTINE 180MG/2ML-1MG
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
41646801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
|
|
BENDAMUSTINE 180MG/2ML-1MG
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
41646801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.43 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.19
|
| Rate for Payer: Aetna Government |
$9.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.43
|
| Rate for Payer: Brighton Health Commercial |
$48.00
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Cash Price |
$9.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.19
|
| Rate for Payer: EmblemHealth Commercial |
$9.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.65
|
| Rate for Payer: Group Health Inc Commercial |
$9.19
|
| Rate for Payer: Group Health Inc Medicare |
$9.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.81
|
| Rate for Payer: Healthfirst QHP |
$9.19
|
| Rate for Payer: Humana Medicare |
$9.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.19
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$8.86
|
| Rate for Payer: SOMOS Essential |
$8.86
|
| Rate for Payer: United Healthcare Commercial |
$14.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.35
|
| Rate for Payer: Wellcare Medicare |
$8.73
|
|
|
BENDAMUSTINE HCL 100 MG IV SOLR [91300]
|
Facility
|
IP
|
$3,566.16
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
63459039120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,783.08 |
| Max. Negotiated Rate |
$1,783.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,783.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,783.08
|
|
|
BENDAMUSTINE HCL 100 MG IV SOLR [91300]
|
Facility
|
OP
|
$3,566.16
|
|
|
Service Code
|
HCPCS J9033
|
| Hospital Charge Code |
63459039120
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7.35 |
| Max. Negotiated Rate |
$2,318.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,961.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.19
|
| Rate for Payer: Aetna Government |
$9.19
|
| Rate for Payer: Brighton Health Commercial |
$2,139.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,783.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,050.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,783.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.19
|
| Rate for Payer: Group Health Inc Commercial |
$9.19
|
| Rate for Payer: Group Health Inc Medicare |
$9.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,783.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,783.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.81
|
| Rate for Payer: Healthfirst QHP |
$9.19
|
| Rate for Payer: Humana Medicare |
$9.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,318.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.35
|
|
|
BENDING PRESS INSERT, CONCAVE
|
Facility
|
OP
|
$563.62
|
|
| Hospital Charge Code |
40006768
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.27 |
| Max. Negotiated Rate |
$450.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$309.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$281.81
|
| Rate for Payer: Aetna Government |
$281.81
|
| Rate for Payer: Brighton Health Commercial |
$422.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$450.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$383.26
|
| Rate for Payer: Group Health Inc Commercial |
$281.81
|
| Rate for Payer: Group Health Inc Medicare |
$197.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$281.81
|
|
|
BENDING PRESS INSERT, CONVEX
|
Facility
|
OP
|
$897.34
|
|
| Hospital Charge Code |
40006769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$314.07 |
| Max. Negotiated Rate |
$717.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$493.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$448.67
|
| Rate for Payer: Aetna Government |
$448.67
|
| Rate for Payer: Brighton Health Commercial |
$673.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$717.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$610.19
|
| Rate for Payer: Group Health Inc Commercial |
$448.67
|
| Rate for Payer: Group Health Inc Medicare |
$314.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$448.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$448.67
|
|
|
BENDING TEMPLATE FOR LCKNG PLATES
|
Facility
|
OP
|
$130.00
|
|
| Hospital Charge Code |
40209531
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.00
|
| Rate for Payer: Aetna Government |
$65.00
|
| Rate for Payer: Brighton Health Commercial |
$97.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
| Rate for Payer: Group Health Inc Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Medicare |
$45.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITH MCC
|
Facility
|
IP
|
$33,736.84
|
|
|
Service Code
|
MSDRG 725
|
| Min. Negotiated Rate |
$10,640.70 |
| Max. Negotiated Rate |
$33,736.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18,297.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,535.88
|
| Rate for Payer: Aetna Government |
$24,535.88
|
| Rate for Payer: Brighton Health Commercial |
$17,993.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25,026.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21,429.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,684.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,309.09
|
| Rate for Payer: EmblemHealth Commercial |
$10,640.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,535.88
|
| Rate for Payer: Group Health Inc Commercial |
$24,535.88
|
| Rate for Payer: Group Health Inc Medicare |
$24,535.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,535.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,409.18
|
| Rate for Payer: Humana Medicare |
$33,736.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,535.88
|
| Rate for Payer: United Healthcare Commercial |
$24,677.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,535.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,535.88
|
| Rate for Payer: Wellcare Medicare |
$23,309.09
|
|
|
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC
|
Facility
|
IP
|
$24,012.33
|
|
|
Service Code
|
MSDRG 726
|
| Min. Negotiated Rate |
$6,267.47 |
| Max. Negotiated Rate |
$24,012.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,777.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,463.51
|
| Rate for Payer: Aetna Government |
$17,463.51
|
| Rate for Payer: Brighton Health Commercial |
$10,598.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,812.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,621.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,416.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,590.33
|
| Rate for Payer: EmblemHealth Commercial |
$6,267.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,463.51
|
| Rate for Payer: Group Health Inc Commercial |
$17,463.51
|
| Rate for Payer: Group Health Inc Medicare |
$17,463.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,463.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,120.53
|
| Rate for Payer: Humana Medicare |
$24,012.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,463.51
|
| Rate for Payer: United Healthcare Commercial |
$14,535.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,463.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,463.51
|
| Rate for Payer: Wellcare Medicare |
$16,590.33
|
|
|
BENIGN-RMVL SKN LESION 1.1-2.0 CM
|
Facility
|
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
30300173
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Humana Medicare |
$1,912.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
BENIGN-RMVL SKN LESION 1.1-2.0 CM
|
Facility
|
IP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 11422
|
| Hospital Charge Code |
30300173
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,874.89
|
|
