|
SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PACK [162642]
|
Facility
|
OP
|
$32.82
|
|
|
Service Code
|
NDC 00310111039
|
| Hospital Charge Code |
00310111039
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.49 |
| Max. Negotiated Rate |
$26.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.41
|
| Rate for Payer: Aetna Government |
$16.41
|
| Rate for Payer: Brighton Health Commercial |
$24.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.32
|
| Rate for Payer: Group Health Inc Commercial |
$16.41
|
| Rate for Payer: Group Health Inc Medicare |
$11.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.33
|
|
|
SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PACK [162642]
|
Facility
|
OP
|
$32.82
|
|
|
Service Code
|
NDC 00310111030
|
| Hospital Charge Code |
00310111030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.49 |
| Max. Negotiated Rate |
$26.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.41
|
| Rate for Payer: Aetna Government |
$16.41
|
| Rate for Payer: Brighton Health Commercial |
$24.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.32
|
| Rate for Payer: Group Health Inc Commercial |
$16.41
|
| Rate for Payer: Group Health Inc Medicare |
$11.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21.33
|
|
|
SOD NITRITE-SOD THIOSULF 30-250MG
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
41647993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.00
|
| Rate for Payer: Aetna Government |
$150.00
|
| Rate for Payer: Brighton Health Commercial |
$225.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.00
|
| Rate for Payer: Group Health Inc Commercial |
$150.00
|
| Rate for Payer: Group Health Inc Medicare |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.00
|
|
|
SOD NITRITE-SPD THIOSULF 30-250MG
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
41657993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150.00
|
| Rate for Payer: Aetna Government |
$150.00
|
| Rate for Payer: Brighton Health Commercial |
$225.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.00
|
| Rate for Payer: Group Health Inc Commercial |
$150.00
|
| Rate for Payer: Group Health Inc Medicare |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.00
|
|
|
SOFOSBUVIR 400 MG PO TABS [124996]
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
NDC 61958150101
|
| Hospital Charge Code |
61958150101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$960.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$600.00
|
| Rate for Payer: Aetna Government |
$600.00
|
| Rate for Payer: Brighton Health Commercial |
$900.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$960.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$816.00
|
| Rate for Payer: Group Health Inc Commercial |
$600.00
|
| Rate for Payer: Group Health Inc Medicare |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$780.00
|
|
|
SOFSILK BK
|
Facility
|
OP
|
$2.38
|
|
| Hospital Charge Code |
64907073
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.19
|
| Rate for Payer: Aetna Government |
$1.19
|
| Rate for Payer: Brighton Health Commercial |
$1.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.62
|
| Rate for Payer: Group Health Inc Commercial |
$1.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.19
|
|
|
SOFT ANCHOR SELF
|
Facility
|
OP
|
$1,100.00
|
|
| Hospital Charge Code |
64907518
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$605.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$550.00
|
| Rate for Payer: Aetna Government |
$550.00
|
| Rate for Payer: Brighton Health Commercial |
$825.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$880.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$748.00
|
| Rate for Payer: Group Health Inc Commercial |
$550.00
|
| Rate for Payer: Group Health Inc Medicare |
$385.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$550.00
|
|
|
SOFT DISP SNARE 25MM X 230
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
64906240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Brighton Health Commercial |
$5.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$4.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.45
|
| Rate for Payer: Group Health Inc Commercial |
$4.50
|
| Rate for Payer: Group Health Inc Medicare |
$3.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.85
|
|
|
SOFT DISP SNARE 25MM X 230
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
64906240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.50
|
|
|
SOFT TISSUE ALLOGRAFT
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS D4275
|
| Hospital Charge Code |
42303393
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$500.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,763.60
|
| Rate for Payer: Aetna Government |
$1,763.60
|
| Rate for Payer: Brighton Health Commercial |
$750.00
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Cash Price |
$1,763.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,763.60
|
| 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 |
$1,763.60
|
| Rate for Payer: EmblemHealth Commercial |
$1,763.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,499.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,569.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,763.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,569.60
|
| Rate for Payer: Group Health Inc Commercial |
$1,763.60
|
| Rate for Payer: Group Health Inc Medicare |
$1,763.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,763.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,499.06
|
| Rate for Payer: Healthfirst QHP |
$1,763.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,763.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,763.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,410.88
|
| Rate for Payer: Wellcare Medicare |
$1,675.42
|
|
|
SOFT TISSUE ALLOGRAFT
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
HCPCS D4275
|
| Hospital Charge Code |
42303393
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,763.60
|
|
|
SOFT TISSUE PROCEDURES WITH CC
|
Facility
|
IP
|
$32,025.40
|
|
|
Service Code
|
MSDRG 501
|
| Min. Negotiated Rate |
$14,599.81 |
| Max. Negotiated Rate |
$32,025.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25,592.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31,397.45
|
| Rate for Payer: Aetna Government |
$31,397.45
|
| Rate for Payer: Brighton Health Commercial |
$25,167.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32,025.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29,973.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24,735.67
|
| Rate for Payer: Elderplan Medicare Advantage |
$29,827.58
|
| Rate for Payer: EmblemHealth Commercial |
$14,883.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$31,397.45
|
| Rate for Payer: Group Health Inc Commercial |
$31,397.45
|
| Rate for Payer: Group Health Inc Medicare |
$31,397.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31,397.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,599.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$31,397.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31,397.45
|
| Rate for Payer: Wellcare Medicare |
$29,827.58
|
|
|
SOFT TISSUE PROCEDURES WITH MCC
|
Facility
|
IP
|
$55,999.91
|
|
|
Service Code
|
MSDRG 500
|
| Min. Negotiated Rate |
$24,318.10 |
| Max. Negotiated Rate |
$55,999.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47,815.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52,297.00
|
| Rate for Payer: Aetna Government |
$52,297.00
|
| Rate for Payer: Brighton Health Commercial |
$47,020.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$53,342.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55,999.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46,213.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$49,682.15
|
| Rate for Payer: EmblemHealth Commercial |
$27,807.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$52,297.00
|
| Rate for Payer: Group Health Inc Commercial |
$52,297.00
|
| Rate for Payer: Group Health Inc Medicare |
$52,297.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$52,297.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24,318.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$52,297.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52,297.00
|
| Rate for Payer: Wellcare Medicare |
$49,682.15
|
|
|
SOFT TISSUE PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$27,032.33
|
|
|
Service Code
|
MSDRG 502
|
| Min. Negotiated Rate |
$11,856.70 |
| Max. Negotiated Rate |
$27,032.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,387.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,502.28
|
| Rate for Payer: Aetna Government |
$26,502.28
|
| Rate for Payer: Brighton Health Commercial |
$20,049.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,032.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23,877.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,705.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,177.17
|
| Rate for Payer: EmblemHealth Commercial |
$11,856.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,502.28
|
| Rate for Payer: Group Health Inc Commercial |
$26,502.28
|
| Rate for Payer: Group Health Inc Medicare |
$26,502.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,502.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,323.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,502.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,502.28
|
| Rate for Payer: Wellcare Medicare |
$25,177.17
|
|
|
SOL BICARBONATE HEMO-LIQ 0899914
|
Facility
|
OP
|
$3.32
|
|
| Hospital Charge Code |
40209467
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.66
|
| Rate for Payer: Aetna Government |
$1.66
|
| Rate for Payer: Brighton Health Commercial |
$2.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.26
|
| Rate for Payer: Group Health Inc Commercial |
$1.66
|
| Rate for Payer: Group Health Inc Medicare |
$1.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.66
|
|
|
SOL BICARBONATE RL-01 LQD 4 GL/CS
|
Facility
|
OP
|
$9.81
|
|
| Hospital Charge Code |
64902256
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.90
|
| Rate for Payer: Aetna Government |
$4.90
|
| Rate for Payer: Brighton Health Commercial |
$7.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.67
|
| Rate for Payer: Group Health Inc Commercial |
$4.90
|
| Rate for Payer: Group Health Inc Medicare |
$3.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.90
|
|
|
SOL DIALYSIS PD 2.5 1LT BAG
|
Facility
|
OP
|
$10.64
|
|
| Hospital Charge Code |
64902161
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.32
|
| Rate for Payer: Aetna Government |
$5.32
|
| Rate for Payer: Brighton Health Commercial |
$7.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.24
|
| Rate for Payer: Group Health Inc Commercial |
$5.32
|
| Rate for Payer: Group Health Inc Medicare |
$3.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.32
|
|
|
SOL DIALYSIS PD 4.25 2 1/2LT
|
Facility
|
OP
|
$83.75
|
|
| Hospital Charge Code |
64902278
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$29.31 |
| Max. Negotiated Rate |
$67.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$41.88
|
| Rate for Payer: Aetna Government |
$41.88
|
| Rate for Payer: Brighton Health Commercial |
$62.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$67.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56.95
|
| Rate for Payer: Group Health Inc Commercial |
$41.88
|
| Rate for Payer: Group Health Inc Medicare |
$29.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.88
|
|
|
SOL DIALYSIS PD 4.25 3LT BAG
|
Facility
|
OP
|
$13.88
|
|
| Hospital Charge Code |
64902000
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$11.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.94
|
| Rate for Payer: Aetna Government |
$6.94
|
| Rate for Payer: Brighton Health Commercial |
$10.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.44
|
| Rate for Payer: Group Health Inc Commercial |
$6.94
|
| Rate for Payer: Group Health Inc Medicare |
$4.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.94
|
|
|
SOL FORMALIN 10% BUFFRD
|
Facility
|
OP
|
$20.80
|
|
| Hospital Charge Code |
64901310
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$16.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.40
|
| Rate for Payer: Aetna Government |
$10.40
|
| Rate for Payer: Brighton Health Commercial |
$15.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.14
|
| Rate for Payer: Group Health Inc Commercial |
$10.40
|
| Rate for Payer: Group Health Inc Medicare |
$7.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.40
|
|
|
SOL GLUCOSE CONTROL COMFORT CURVE
|
Facility
|
OP
|
$2.92
|
|
| Hospital Charge Code |
64901053
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.46
|
| Rate for Payer: Aetna Government |
$1.46
|
| Rate for Payer: Brighton Health Commercial |
$2.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.99
|
| Rate for Payer: Group Health Inc Commercial |
$1.46
|
| Rate for Payer: Group Health Inc Medicare |
$1.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.46
|
|
|
SOL. HEPARINIZED SALINE
|
Facility
|
OP
|
$81.69
|
|
| Hospital Charge Code |
64902780
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$28.59 |
| Max. Negotiated Rate |
$65.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.84
|
| Rate for Payer: Aetna Government |
$40.84
|
| Rate for Payer: Brighton Health Commercial |
$61.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.55
|
| Rate for Payer: Group Health Inc Commercial |
$40.84
|
| Rate for Payer: Group Health Inc Medicare |
$28.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.84
|
|
|
SOLIA S PROMRI 45 LEAD 377176
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
66573254
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.92
|
| Rate for Payer: Aetna Government |
$98.92
|
| Rate for Payer: Brighton Health Commercial |
$600.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$575.00
|
| Rate for Payer: EmblemHealth Commercial |
$500.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,050.00
|
| Rate for Payer: Group Health Inc Commercial |
$500.00
|
| Rate for Payer: Group Health Inc Medicare |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$500.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$650.00
|
|
|
SOLIA S PROMRI 53 LEAD 377177
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
66573255
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$770.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.92
|
| Rate for Payer: Aetna Government |
$98.92
|
| Rate for Payer: Brighton Health Commercial |
$840.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$700.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$805.00
|
| Rate for Payer: EmblemHealth Commercial |
$700.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,470.00
|
| Rate for Payer: Group Health Inc Commercial |
$700.00
|
| Rate for Payer: Group Health Inc Medicare |
$490.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$910.00
|
|
|
SOLIA S PROMRI 60 LEAD 377179
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
HCPCS C1898
|
| Hospital Charge Code |
66573256
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$550.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$98.92
|
| Rate for Payer: Aetna Government |
$98.92
|
| Rate for Payer: Brighton Health Commercial |
$600.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$575.00
|
| Rate for Payer: EmblemHealth Commercial |
$500.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,050.00
|
| Rate for Payer: Group Health Inc Commercial |
$500.00
|
| Rate for Payer: Group Health Inc Medicare |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$500.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$650.00
|
|
