|
SIMPLE REPR SUPERFCL WOUND - FACE
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
30101154
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$231.52
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
SIMPLE REPR SUPERFCL WOUND/FACE
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
30306670
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
SIMPLE REPR SUPERFCL WOUND/FACE
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 12011
|
| Hospital Charge Code |
30306670
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
SIMPLE SYRUP PO SYRP [7242]
|
Facility
|
OP
|
$0.04
|
|
|
Service Code
|
NDC 31722093747
|
| Hospital Charge Code |
31722093747
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Brighton Health Commercial |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
SIMP REAPIR FACE/EAR/EYE > 30 CM
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
30105185
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$231.52
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$231.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
SIMP REAPIR FACE/EAR/EYE > 30 CM
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 12018
|
| Hospital Charge Code |
30105185
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
SIM - SINGLE TREAT AREA
|
Facility
|
IP
|
$383.40
|
|
|
Service Code
|
HCPCS 77280 TC
|
| Hospital Charge Code |
66542927
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$156.91
|
|
|
SIM - SINGLE TREAT AREA
|
Facility
|
OP
|
$383.40
|
|
|
Service Code
|
HCPCS 77280 TC
|
| Hospital Charge Code |
66542927
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$109.84 |
| Max. Negotiated Rate |
$306.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$210.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$156.91
|
| Rate for Payer: Aetna Government |
$156.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$109.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$109.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$109.84
|
| Rate for Payer: Brighton Health Commercial |
$287.55
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Cash Price |
$156.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$156.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$306.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$260.71
|
| Rate for Payer: Elderplan Medicare Advantage |
$156.91
|
| Rate for Payer: EmblemHealth Commercial |
$156.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$156.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$156.91
|
| Rate for Payer: Group Health Inc Medicare |
$156.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$156.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$156.91
|
| Rate for Payer: Healthfirst QHP |
$156.91
|
| Rate for Payer: Humana Medicare |
$160.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$156.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$125.53
|
| Rate for Payer: Wellcare Medicare |
$149.06
|
|
|
SIM - TWO SEP TREAT AREAS
|
Facility
|
OP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77285 TC
|
| Hospital Charge Code |
66542928
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$279.92 |
| Max. Negotiated Rate |
$812.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$558.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$427.29
|
| Rate for Payer: Aetna Government |
$427.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$299.10
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$299.10
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$299.10
|
| Rate for Payer: Brighton Health Commercial |
$761.35
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Cash Price |
$427.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$427.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$812.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$690.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$427.29
|
| Rate for Payer: EmblemHealth Commercial |
$427.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$427.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$427.29
|
| Rate for Payer: Group Health Inc Medicare |
$427.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$507.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$384.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$427.29
|
| Rate for Payer: Healthfirst QHP |
$427.29
|
| Rate for Payer: Humana Medicare |
$435.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$427.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$427.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$341.83
|
| Rate for Payer: Wellcare Medicare |
$405.93
|
|
|
SIM - TWO SEP TREAT AREAS
|
Facility
|
IP
|
$1,015.13
|
|
|
Service Code
|
HCPCS 77285 TC
|
| Hospital Charge Code |
66542928
|
|
Hospital Revenue Code
|
333
|
| Rate for Payer: Cash Price |
$427.29
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT
|
Facility
|
IP
|
$104,639.43
|
|
|
Service Code
|
MSDRG 008
|
| Min. Negotiated Rate |
$37,336.64 |
| Max. Negotiated Rate |
$104,639.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77,583.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80,293.86
|
| Rate for Payer: Aetna Government |
$80,293.86
|
| Rate for Payer: Brighton Health Commercial |
$76,294.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81,899.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90,864.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74,985.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$76,279.17
|
| Rate for Payer: EmblemHealth Commercial |
$45,119.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$80,293.86
|
| Rate for Payer: Group Health Inc Commercial |
$80,293.86
|
| Rate for Payer: Group Health Inc Medicare |
$80,293.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$80,293.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$37,336.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80,293.86
|
| Rate for Payer: United Healthcare Commercial |
$104,639.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80,293.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$80,293.86
|
| Rate for Payer: Wellcare Medicare |
$76,279.17
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS
|
Facility
|
IP
|
$162,493.07
|
|
|
Service Code
|
MSDRG 019
|
| Min. Negotiated Rate |
$54,952.20 |
| Max. Negotiated Rate |
$162,493.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$117,864.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$118,176.78
|
| Rate for Payer: Aetna Government |
$118,176.78
|
| Rate for Payer: Brighton Health Commercial |
$115,905.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$120,540.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$138,039.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113,916.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$112,267.94
|
| Rate for Payer: EmblemHealth Commercial |
$68,544.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$118,176.78
|
| Rate for Payer: Group Health Inc Commercial |
$118,176.78
|
| Rate for Payer: Group Health Inc Medicare |
$118,176.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118,176.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$54,952.20
|
| Rate for Payer: Humana Medicare |
$162,493.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$118,176.78
|
| Rate for Payer: United Healthcare Commercial |
$158,966.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118,176.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118,176.78
|
| Rate for Payer: Wellcare Medicare |
$112,267.94
|
|
|
SIMVASTATIN 10 MG PO TABS [11364]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 63739057110
|
| Hospital Charge Code |
63739057110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
SIMVASTATIN 10 MG PO TABS [11364]
|
Facility
|
OP
|
$2.81
|
|
|
Service Code
|
NDC 16729000415
|
| Hospital Charge Code |
16729000415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.41
|
| Rate for Payer: Aetna Government |
$1.41
|
| Rate for Payer: Brighton Health Commercial |
$2.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.91
|
| Rate for Payer: Group Health Inc Commercial |
$1.41
|
| Rate for Payer: Group Health Inc Medicare |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.83
|
|
|
SIMVASTATIN 10 MG TAB
|
Facility
|
OP
|
$0.20
|
|
| Hospital Charge Code |
41652624
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
SIMVASTATIN 10 MG TAB
|
Facility
|
OP
|
$0.20
|
|
| Hospital Charge Code |
41642624
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
SIMVASTATIN 20 MG PO TABS [11365]
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
NDC 16729000517
|
| Hospital Charge Code |
16729000517
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Brighton Health Commercial |
$3.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.34
|
| Rate for Payer: Group Health Inc Commercial |
$2.46
|
| Rate for Payer: Group Health Inc Medicare |
$1.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.20
|
|
|
SIMVASTATIN 20 MG PO TABS [11365]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 63739057210
|
| Hospital Charge Code |
63739057210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
SIMVASTATIN 20 MG PO TABS [11365]
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
NDC 68084051211
|
| Hospital Charge Code |
68084051211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Brighton Health Commercial |
$3.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.35
|
| Rate for Payer: Group Health Inc Commercial |
$2.46
|
| Rate for Payer: Group Health Inc Medicare |
$1.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.20
|
|
|
SIMVASTATIN 20 MG TAB
|
Facility
|
OP
|
$0.20
|
|
| Hospital Charge Code |
41652621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
SIMVASTATIN 20 MG TAB
|
Facility
|
OP
|
$0.20
|
|
| Hospital Charge Code |
41642621
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
SIMVASTATIN 40 MG PO TABS [11366]
|
Facility
|
OP
|
$4.90
|
|
|
Service Code
|
NDC 65862005399
|
| Hospital Charge Code |
65862005399
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.45
|
| Rate for Payer: Aetna Government |
$2.45
|
| Rate for Payer: Brighton Health Commercial |
$3.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.33
|
| Rate for Payer: Group Health Inc Commercial |
$2.45
|
| Rate for Payer: Group Health Inc Medicare |
$1.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.19
|
|
|
SIMVASTATIN 40 MG PO TABS [11366]
|
Facility
|
OP
|
$0.21
|
|
|
Service Code
|
NDC 63739057310
|
| Hospital Charge Code |
63739057310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
SIMVASTATIN 40 MG PO TABS [11366]
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
NDC 70377000415
|
| Hospital Charge Code |
70377000415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Brighton Health Commercial |
$3.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.34
|
| Rate for Payer: Group Health Inc Commercial |
$2.46
|
| Rate for Payer: Group Health Inc Medicare |
$1.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.20
|
|
|
SIMVASTATIN 40 MG PO TABS [11366]
|
Facility
|
OP
|
$4.90
|
|
|
Service Code
|
NDC 65862005390
|
| Hospital Charge Code |
65862005390
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.45
|
| Rate for Payer: Aetna Government |
$2.45
|
| Rate for Payer: Brighton Health Commercial |
$3.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.33
|
| Rate for Payer: Group Health Inc Commercial |
$2.45
|
| Rate for Payer: Group Health Inc Medicare |
$1.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.19
|
|
