|
SONOGRAM - LIMITED
|
Facility
|
IP
|
$339.45
|
|
|
Service Code
|
HCPCS 76815 TC
|
| Hospital Charge Code |
40250900
|
|
Hospital Revenue Code
|
402
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
SONOGRAM - LIMITED
|
Facility
|
OP
|
$339.45
|
|
|
Service Code
|
HCPCS 76815 TC
|
| Hospital Charge Code |
40250900
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$186.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$124.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$105.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$49.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
SORBITOL 70 % SOLN [93927]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 46287050030
|
| Hospital Charge Code |
46287050030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Brighton Health Commercial |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
|
SORBITOL 70% SOLUTION
|
Facility
|
OP
|
$1.23
|
|
| Hospital Charge Code |
41642361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.62
|
| Rate for Payer: Aetna Government |
$0.62
|
| Rate for Payer: Brighton Health Commercial |
$0.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.62
|
| Rate for Payer: Group Health Inc Medicare |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.80
|
|
|
SORBITOL 70% SOLUTION
|
Facility
|
OP
|
$1.23
|
|
| Hospital Charge Code |
41652361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.62
|
| Rate for Payer: Aetna Government |
$0.62
|
| Rate for Payer: Brighton Health Commercial |
$0.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.62
|
| Rate for Payer: Group Health Inc Medicare |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.80
|
|
|
SOTALOL 80 MG TAB
|
Facility
|
OP
|
$0.22
|
|
| Hospital Charge Code |
41651531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
SOTALOL 80 MG TAB
|
Facility
|
OP
|
$0.22
|
|
| Hospital Charge Code |
41641531
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
SOTALOL HCL 80 MG PO TABS [11421]
|
Facility
|
OP
|
$2.35
|
|
|
Service Code
|
NDC 69584084110
|
| Hospital Charge Code |
69584084110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.17
|
| Rate for Payer: Aetna Government |
$1.17
|
| Rate for Payer: Brighton Health Commercial |
$1.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.60
|
| Rate for Payer: Group Health Inc Commercial |
$1.17
|
| Rate for Payer: Group Health Inc Medicare |
$0.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.53
|
|
|
SOTA MED CATH FISH SPLIT 32
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
40203377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$440.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$400.00
|
| Rate for Payer: Aetna Government |
$400.00
|
| Rate for Payer: Brighton Health Commercial |
$600.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$640.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$544.00
|
| Rate for Payer: Group Health Inc Commercial |
$400.00
|
| Rate for Payer: Group Health Inc Medicare |
$280.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
|
|
SOTA MED CATH FISH SPLIT 32
|
Facility
|
OP
|
$800.00
|
|
| Hospital Charge Code |
40009361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$440.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$400.00
|
| Rate for Payer: Aetna Government |
$400.00
|
| Rate for Payer: Brighton Health Commercial |
$600.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$640.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$544.00
|
| Rate for Payer: Group Health Inc Commercial |
$400.00
|
| Rate for Payer: Group Health Inc Medicare |
$280.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$400.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$400.00
|
|
|
SOTRADECOL 1% 2ML INJ
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
41648005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Brighton Health Commercial |
$37.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.00
|
| Rate for Payer: Group Health Inc Commercial |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.50
|
|
|
SOTRADECOL 1% 2ML INJ
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
41658005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.00
|
| Rate for Payer: Aetna Government |
$25.00
|
| Rate for Payer: Brighton Health Commercial |
$37.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.00
|
| Rate for Payer: Group Health Inc Commercial |
$25.00
|
| Rate for Payer: Group Health Inc Medicare |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.50
|
|
|
SOTROVIMAB 500MG/8ML(COVID-19MAB)
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0247
|
| Hospital Charge Code |
41650288
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
SOTROVIMAB 500MG/8ML(COVID-19MAB)
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0247
|
| Hospital Charge Code |
41640288
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
SOTROVIMAB 500MG/8ML(COVID-19MAB)
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0247
|
| Hospital Charge Code |
41650288
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$2,520.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
SOTROVIMAB 500MG/8ML(COVID-19MAB)
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0247
|
| Hospital Charge Code |
41640288
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$2,520.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
SOTROVIMAB INFUSION
|
Facility
|
IP
|
$1,357.80
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
30302526
|
|
Hospital Revenue Code
|
771
|
| Rate for Payer: Cash Price |
$546.78
|
|
|
SOTROVIMAB INFUSION
|
Facility
|
OP
|
$1,357.80
|
|
|
Service Code
|
HCPCS M0247
|
| Hospital Charge Code |
30302526
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$1,086.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$746.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$546.78
|
| Rate for Payer: Aetna Government |
$546.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$382.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$382.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$382.75
|
| Rate for Payer: Brighton Health Commercial |
$1,018.35
|
| Rate for Payer: Cash Price |
$546.78
|
| Rate for Payer: Cash Price |
$546.78
|
| Rate for Payer: Cash Price |
$546.78
|
| Rate for Payer: Cash Price |
$546.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$546.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,086.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$923.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$546.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$464.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$486.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$546.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$486.63
|
| 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 |
$678.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$546.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$464.76
|
| Rate for Payer: Healthfirst QHP |
$546.78
|
| Rate for Payer: Humana Medicare |
$557.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$546.78
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$546.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$546.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$437.42
|
| Rate for Payer: Wellcare Medicare |
$519.44
|
|
|
SOUNDS UTERINE DISPOSABLE SIMS
|
Facility
|
OP
|
$4.70
|
|
| Hospital Charge Code |
64903367
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.35
|
| Rate for Payer: Aetna Government |
$2.35
|
| Rate for Payer: Brighton Health Commercial |
$3.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.20
|
| Rate for Payer: Group Health Inc Commercial |
$2.35
|
| Rate for Payer: Group Health Inc Medicare |
$1.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.35
|
|
|
SP ABCESS CATH. CHANGE
|
Facility
|
IP
|
$711.45
|
|
|
Service Code
|
HCPCS 43762 TC
|
| Hospital Charge Code |
41547458
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$285.81
|
|
|
SP ABCESS CATH. CHANGE
|
Facility
|
OP
|
$711.45
|
|
|
Service Code
|
HCPCS 43762 TC
|
| Hospital Charge Code |
41547458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.07 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$285.81
|
| Rate for Payer: Aetna Government |
$285.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$200.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$200.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$200.07
|
| Rate for Payer: Brighton Health Commercial |
$533.59
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Cash Price |
$285.81
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$285.81
|
| 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 |
$285.81
|
| Rate for Payer: EmblemHealth Commercial |
$285.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$242.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$254.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$285.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$254.37
|
| Rate for Payer: Group Health Inc Commercial |
$285.81
|
| Rate for Payer: Group Health Inc Medicare |
$285.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$242.94
|
| Rate for Payer: Healthfirst QHP |
$285.81
|
| Rate for Payer: Humana Medicare |
$291.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$285.81
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$285.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$285.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$228.65
|
| Rate for Payer: Wellcare Medicare |
$271.52
|
|
|
SP ABCESS CATH. CHECK
|
Facility
|
OP
|
$127.89
|
|
|
Service Code
|
HCPCS 20501 TC
|
| Hospital Charge Code |
41547457
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$44.76 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$118.86
|
| Rate for Payer: Aetna Government |
$118.86
|
| Rate for Payer: Brighton Health Commercial |
$95.92
|
| 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: Group Health Inc Commercial |
$63.94
|
| Rate for Payer: Group Health Inc Medicare |
$44.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.94
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP ABCESSOGRAM (VIA CATHETER)
|
Facility
|
OP
|
$4,542.00
|
|
|
Service Code
|
HCPCS 49424 TC
|
| Hospital Charge Code |
41547628
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$3,406.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$167.20
|
| Rate for Payer: Aetna Government |
$167.20
|
| Rate for Payer: Brighton Health Commercial |
$3,406.50
|
| 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: Group Health Inc Commercial |
$2,271.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,589.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,271.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,271.00
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
SP ABD PARACENTESIS W/IMAGING
|
Facility
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49083 TC
|
| Hospital Charge Code |
41542788
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
SP ABD PARACENTESIS W/IMAGING
|
Facility
|
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49083 TC
|
| Hospital Charge Code |
41542788
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$733.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| Rate for Payer: Brighton Health Commercial |
$1,785.26
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,048.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
