|
CABOTEGRAVIR + RILPIVIRINE 4ML
|
Facility
OP
|
$23.76
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$15.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.88
|
| Rate for Payer: Aetna Government |
$11.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.66
|
| Rate for Payer: Group Health Inc Commercial |
$11.88
|
| Rate for Payer: Group Health Inc Medicare |
$8.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.44
|
|
|
CABOTEGRAVIR + RILPIVIRINE 4ML
|
Facility
OP
|
$23.76
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$15.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.88
|
| Rate for Payer: Aetna Government |
$11.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.66
|
| Rate for Payer: Group Health Inc Commercial |
$11.88
|
| Rate for Payer: Group Health Inc Medicare |
$8.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.44
|
|
|
CABOTEGRAVIR + RILPIVIRINE 4ML
|
Facility
IP
|
$23.76
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.88
|
|
|
CABOTEGRAVIR + RILPIVIRINE 4ML
|
Facility
IP
|
$23.76
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.88
|
|
|
CABOTEGRAVIR + RILPIVIRINE 6ML
|
Facility
OP
|
$23.76
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
41640260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$23.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.60
|
| Rate for Payer: Aetna Government |
$22.60
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.60
|
| Rate for Payer: EmblemHealth Commercial |
$22.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.73
|
| Rate for Payer: Group Health Inc Commercial |
$22.60
|
| Rate for Payer: Group Health Inc Medicare |
$22.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.21
|
| Rate for Payer: Healthfirst QHP |
$22.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.97
|
| Rate for Payer: SOMOS Essential |
$23.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.08
|
| Rate for Payer: Wellcare Medicare |
$21.47
|
|
|
CABOTEGRAVIR + RILPIVIRINE 6ML
|
Facility
IP
|
$23.76
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
41640260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.88
|
|
|
CABOTEGRAVIR + RILPIVIRINE 6ML
|
Facility
OP
|
$23.76
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
41650260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$23.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.60
|
| Rate for Payer: Aetna Government |
$22.60
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.60
|
| Rate for Payer: EmblemHealth Commercial |
$22.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.73
|
| Rate for Payer: Group Health Inc Commercial |
$22.60
|
| Rate for Payer: Group Health Inc Medicare |
$22.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.21
|
| Rate for Payer: Healthfirst QHP |
$22.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.60
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23.97
|
| Rate for Payer: SOMOS Essential |
$23.97
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.08
|
| Rate for Payer: Wellcare Medicare |
$21.47
|
|
|
CABOTEGRAVIR + RILPIVIRINE 6ML
|
Facility
IP
|
$23.76
|
|
|
Service Code
|
HCPCS J0741
|
| Hospital Charge Code |
41650260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.88
|
|
|
CADMIUM, URINE
|
Facility
OP
|
$59.10
|
|
|
Service Code
|
HCPCS 82300
|
| Hospital Charge Code |
40608277
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.91 |
| Max. Negotiated Rate |
$36.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.64
|
| Rate for Payer: Aetna Government |
$23.64
|
| Rate for Payer: Cash Price |
$23.64
|
| Rate for Payer: Cash Price |
$23.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$23.64
|
| Rate for Payer: EmblemHealth Commercial |
$23.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.04
|
| Rate for Payer: Group Health Inc Commercial |
$23.64
|
| Rate for Payer: Group Health Inc Medicare |
$23.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.64
|
| Rate for Payer: Healthfirst QHP |
$23.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18.91
|
| Rate for Payer: Wellcare Medicare |
$21.28
|
|
|
CAFFEINE CITRATE 20 MG/ML INJ
|
Facility
OP
|
$5.88
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
41653155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna Government |
$0.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$2.94
|
| Rate for Payer: Group Health Inc Medicare |
$2.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.82
|
|
|
CAFFEINE CITRATE 20 MG/ML INJ
|
Facility
OP
|
$5.88
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
41643155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.69
|
| Rate for Payer: Aetna Government |
$0.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$2.94
|
| Rate for Payer: Group Health Inc Medicare |
$2.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.82
|
|
|
CAFFEINE CITRATE 20 MG/ML INJ
|
Facility
IP
|
$5.88
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
41643155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.94
|
|
|
CAFFEINE CITRATE 20 MG/ML INJ
|
Facility
IP
|
$5.88
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
41653155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.94
|
|
|
CAFFEINE CITRATE 20 MG/ML LIQUID NEONATA
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
41643157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.00
|
| Rate for Payer: Aetna Government |
$17.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.12
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
|
CAFFEINE CITRATE 20 MG/ML LIQUID NEONATA
|
Facility
OP
|
$34.00
|
|
| Hospital Charge Code |
41653157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.00
|
| Rate for Payer: Aetna Government |
$17.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.12
|
| Rate for Payer: Group Health Inc Commercial |
$17.00
|
| Rate for Payer: Group Health Inc Medicare |
$11.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.10
|
|
|
CAGE ANCHOR-C 11 X 12 X 14 X 4DEG
|
Facility
OP
|
$11,737.46
|
|
| Hospital Charge Code |
64906589
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$4,108.11 |
| Max. Negotiated Rate |
$9,389.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,455.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5,868.73
|
| Rate for Payer: Aetna Government |
$5,868.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9,389.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,981.47
|
| Rate for Payer: Group Health Inc Commercial |
$5,868.73
|
| Rate for Payer: Group Health Inc Medicare |
$4,108.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,868.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,868.73
|
|
|
CAGE ANCHOR-C 6X12X14X4DG-4832106
|
Facility
IP
|
$5,868.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,934.36 |
| Max. Negotiated Rate |
$2,934.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,934.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,934.36
|
|
|
CAGE ANCHOR-C 6X12X14X4DG-4832106
|
Facility
OP
|
$5,868.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$6,162.17 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,227.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,934.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,374.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,162.17
|
| Rate for Payer: Group Health Inc Commercial |
$2,934.36
|
| Rate for Payer: Group Health Inc Medicare |
$2,054.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,934.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,934.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,814.67
|
|
|
CAGE BENGAL 4MM
|
Facility
OP
|
$3,930.00
|
|
| Hospital Charge Code |
40205537
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,375.50 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,161.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,965.00
|
| Rate for Payer: Aetna Government |
$1,965.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,144.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,672.40
|
| Rate for Payer: Group Health Inc Commercial |
$1,965.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,375.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,965.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,965.00
|
|
|
CAGE BENGAL 5MM
|
Facility
OP
|
$3,440.00
|
|
| Hospital Charge Code |
40200937
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,204.00 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,892.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,720.00
|
| Rate for Payer: Aetna Government |
$1,720.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,752.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,339.20
|
| Rate for Payer: Group Health Inc Commercial |
$1,720.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,204.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,720.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,720.00
|
|
|
CAGE BENGAL 6MM
|
Facility
OP
|
$3,440.00
|
|
| Hospital Charge Code |
40200938
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,204.00 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,892.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,720.00
|
| Rate for Payer: Aetna Government |
$1,720.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,752.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,339.20
|
| Rate for Payer: Group Health Inc Commercial |
$1,720.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,204.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,720.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,720.00
|
|
|
CAGE BENGAL 7MM
|
Facility
OP
|
$3,440.00
|
|
| Hospital Charge Code |
40200939
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,204.00 |
| Max. Negotiated Rate |
$2,752.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,892.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,720.00
|
| Rate for Payer: Aetna Government |
$1,720.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,752.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,339.20
|
| Rate for Payer: Group Health Inc Commercial |
$1,720.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,204.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,720.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,720.00
|
|
|
CAGE BENGAL 9MM
|
Facility
OP
|
$3,550.00
|
|
| Hospital Charge Code |
40205538
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,242.50 |
| Max. Negotiated Rate |
$2,840.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,952.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,775.00
|
| Rate for Payer: Aetna Government |
$1,775.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,840.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,414.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,775.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,242.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,775.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,775.00
|
|
|
CAGE CAPRI 30MM
|
Facility
OP
|
$17,812.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,234.38 |
| Max. Negotiated Rate |
$18,703.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,796.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,906.25
|
| Rate for Payer: Aetna Government |
$8,906.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8,906.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,242.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,703.12
|
| Rate for Payer: Group Health Inc Commercial |
$8,906.25
|
| Rate for Payer: Group Health Inc Medicare |
$6,234.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,906.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,906.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11,578.12
|
|
|
CAGE CAPRI 30MM
|
Facility
IP
|
$17,812.50
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
64907491
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,906.25 |
| Max. Negotiated Rate |
$8,906.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,906.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,906.25
|
|
