|
CAGE COROENT 12X38X28MM XLR
|
Facility
OP
|
$16,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$17,776.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,311.50
|
| 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 |
$8,465.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,734.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,776.50
|
| Rate for Payer: Group Health Inc Commercial |
$8,465.00
|
| Rate for Payer: Group Health Inc Medicare |
$5,925.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,465.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,465.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11,004.50
|
|
|
CAGE COROENT 12X38X28MM XLR
|
Facility
IP
|
$16,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64905042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,465.00 |
| Max. Negotiated Rate |
$8,465.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,465.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8,465.00
|
|
|
CAGE SPINE 12 12MM (336612012)
|
Facility
IP
|
$1,829.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.77 |
| Max. Negotiated Rate |
$914.77 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$914.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$914.77
|
|
|
CAGE SPINE 12 12MM (336612012)
|
Facility
OP
|
$1,829.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906384
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,921.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,006.25
|
| 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 |
$914.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,051.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,921.02
|
| Rate for Payer: Group Health Inc Commercial |
$914.77
|
| Rate for Payer: Group Health Inc Medicare |
$640.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$914.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$914.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,189.20
|
|
|
CAGE SPNL
|
Facility
OP
|
$18,750.00
|
|
| Hospital Charge Code |
64907240
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$6,562.50 |
| Max. Negotiated Rate |
$15,000.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,312.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,375.00
|
| Rate for Payer: Aetna Government |
$9,375.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,750.00
|
| Rate for Payer: Group Health Inc Commercial |
$9,375.00
|
| Rate for Payer: Group Health Inc Medicare |
$6,562.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,375.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,375.00
|
|
|
CAGE UBOSS 40MM 12 DI (336612040)
|
Facility
IP
|
$3,811.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,905.71 |
| Max. Negotiated Rate |
$1,905.71 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,905.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,905.71
|
|
|
CAGE UBOSS 40MM 12 DI (336612040)
|
Facility
OP
|
$3,811.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64906386
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$4,001.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,096.28
|
| 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 |
$1,905.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,191.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,001.99
|
| Rate for Payer: Group Health Inc Commercial |
$1,905.71
|
| Rate for Payer: Group Health Inc Medicare |
$1,334.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,905.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,905.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,477.42
|
|
|
CALAMINE + ZINC OXIDE LOTION 120 ML
|
Facility
OP
|
$1.42
|
|
| Hospital Charge Code |
41645113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.71
|
| Rate for Payer: Aetna Government |
$0.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.97
|
| Rate for Payer: Group Health Inc Commercial |
$0.71
|
| Rate for Payer: Group Health Inc Medicare |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.92
|
|
|
CALAMINE + ZINC OXIDE LOTION 120 ML
|
Facility
OP
|
$1.42
|
|
| Hospital Charge Code |
41655113
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.71
|
| Rate for Payer: Aetna Government |
$0.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.97
|
| Rate for Payer: Group Health Inc Commercial |
$0.71
|
| Rate for Payer: Group Health Inc Medicare |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.92
|
|
|
CAL BMI NORM PARAMETERS
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8420
|
| Hospital Charge Code |
30307854
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$250.00 |
| 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 |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
CALCANEOUS BONE GRAFT
|
Facility
IP
|
$1,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.00 |
| Max. Negotiated Rate |
$790.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$790.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$790.00
|
|
|
CALCANEOUS BONE GRAFT
|
Facility
OP
|
$1,580.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40209551
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,659.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$869.00
|
| 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 |
$790.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$908.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,659.00
|
| Rate for Payer: Group Health Inc Commercial |
$790.00
|
| Rate for Payer: Group Health Inc Medicare |
$553.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$790.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$790.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,027.00
|
|
|
CALC BMI ABV UP PARAM F/U
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8417
|
| Hospital Charge Code |
30307862
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$250.00 |
| 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 |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
CALC BMI BLW LOW PARAM F/U
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8418
|
| Hospital Charge Code |
30307863
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$250.00 |
| 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 |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
CALC BMI OUT NRM PARAM NO F/U
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G8419
|
| Hospital Charge Code |
30307865
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$250.00 |
| 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 |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
CALCHECK, CHEM VELOCITY
|
Facility
OP
|
$226.43
|
|
| Hospital Charge Code |
64903566
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$181.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$124.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$113.22
|
| Rate for Payer: Aetna Government |
$113.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$181.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$153.97
|
| Rate for Payer: Group Health Inc Commercial |
$113.22
|
| Rate for Payer: Group Health Inc Medicare |
$79.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.22
|
|
|
CALCITONIN SALMON 1 INTL UNIT TEST DOSE
|
Facility
OP
|
$49.00
|
|
| Hospital Charge Code |
41653250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$39.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.50
|
| Rate for Payer: Aetna Government |
$24.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.32
|
| Rate for Payer: Group Health Inc Commercial |
$24.50
|
| Rate for Payer: Group Health Inc Medicare |
$17.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.85
|
|
|
CALCITONIN SALMON 1 INTL UNIT TEST DOSE
|
Facility
OP
|
$49.00
|
|
| Hospital Charge Code |
41643250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$39.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.50
|
| Rate for Payer: Aetna Government |
$24.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.32
|
| Rate for Payer: Group Health Inc Commercial |
$24.50
|
| Rate for Payer: Group Health Inc Medicare |
$17.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$31.85
|
|
|
CALCITONIN SALMON 200 INTL UNITS/ML INJ
|
Facility
OP
|
$6,509.00
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
41653249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$855.60 |
| Max. Negotiated Rate |
$4,230.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,579.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,069.50
|
| Rate for Payer: Aetna Government |
$1,069.50
|
| Rate for Payer: Cash Price |
$1,069.50
|
| Rate for Payer: Cash Price |
$1,069.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,069.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,254.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,742.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,069.50
|
| Rate for Payer: EmblemHealth Commercial |
$1,069.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,069.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,069.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,122.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,069.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,122.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,069.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,069.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,254.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,254.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,366.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$909.07
|
| Rate for Payer: Healthfirst QHP |
$1,069.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,069.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,167.84
|
| Rate for Payer: SOMOS Essential |
$1,167.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,230.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$855.60
|
| Rate for Payer: Wellcare Medicare |
$1,016.02
|
|
|
CALCITONIN SALMON 200 INTL UNITS/ML INJ
|
Facility
OP
|
$6,509.00
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
41643249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$855.60 |
| Max. Negotiated Rate |
$4,230.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,579.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,069.50
|
| Rate for Payer: Aetna Government |
$1,069.50
|
| Rate for Payer: Cash Price |
$1,069.50
|
| Rate for Payer: Cash Price |
$1,069.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,069.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,254.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,742.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,069.50
|
| Rate for Payer: EmblemHealth Commercial |
$1,069.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,069.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,069.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,122.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,069.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,122.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,069.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,069.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,254.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,254.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,366.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$909.07
|
| Rate for Payer: Healthfirst QHP |
$1,069.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,069.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,167.84
|
| Rate for Payer: SOMOS Essential |
$1,167.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,230.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$855.60
|
| Rate for Payer: Wellcare Medicare |
$1,016.02
|
|
|
CALCITONIN SALMON 200 INTL UNITS/ML INJ
|
Facility
IP
|
$6,509.00
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
41653249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,254.50 |
| Max. Negotiated Rate |
$3,254.50 |
| Rate for Payer: Cash Price |
$1,069.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,254.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,254.50
|
|
|
CALCITONIN SALMON 200 INTL UNITS/ML INJ
|
Facility
IP
|
$6,509.00
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
41643249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,254.50 |
| Max. Negotiated Rate |
$3,254.50 |
| Rate for Payer: Cash Price |
$1,069.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,254.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,254.50
|
|
|
CALCITONIN SALMON NASAL SPRAY 3.7 ML
|
Facility
OP
|
$99.90
|
|
| Hospital Charge Code |
41654817
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.96 |
| Max. Negotiated Rate |
$79.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.95
|
| Rate for Payer: Aetna Government |
$49.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.93
|
| Rate for Payer: Group Health Inc Commercial |
$49.95
|
| Rate for Payer: Group Health Inc Medicare |
$34.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.94
|
|
|
CALCITONIN SALMON NASAL SPRAY 3.7 ML
|
Facility
OP
|
$99.90
|
|
| Hospital Charge Code |
41644817
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.96 |
| Max. Negotiated Rate |
$79.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.95
|
| Rate for Payer: Aetna Government |
$49.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.93
|
| Rate for Payer: Group Health Inc Commercial |
$49.95
|
| Rate for Payer: Group Health Inc Medicare |
$34.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.94
|
|
|
CALCITONIN, SERUM
|
Facility
OP
|
$66.98
|
|
|
Service Code
|
HCPCS 82308
|
| Hospital Charge Code |
40609046
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$42.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.79
|
| Rate for Payer: Aetna Government |
$26.79
|
| Rate for Payer: Cash Price |
$26.79
|
| Rate for Payer: Cash Price |
$26.79
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$26.79
|
| Rate for Payer: EmblemHealth Commercial |
$26.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$22.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$23.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$26.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.84
|
| Rate for Payer: Group Health Inc Commercial |
$26.79
|
| Rate for Payer: Group Health Inc Medicare |
$26.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26.79
|
| Rate for Payer: Healthfirst QHP |
$26.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.43
|
| Rate for Payer: Wellcare Medicare |
$24.11
|
|
