|
CASIRIVIMAB REGN 10933
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS Q0243
|
| Hospital Charge Code |
41640200
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| 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: 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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
CASPOFUNGIN 50 MG INJ - NF
|
Facility
IP
|
$67.17
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
41652573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.58 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.58
|
|
|
CASPOFUNGIN 50 MG INJ - NF
|
Facility
OP
|
$67.17
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
41642573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$43.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.25
|
| Rate for Payer: Aetna Government |
$6.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Group Health Inc Commercial |
$33.58
|
| Rate for Payer: Group Health Inc Medicare |
$23.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.03
|
| Rate for Payer: SOMOS Essential |
$7.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.66
|
|
|
CASPOFUNGIN 50 MG INJ - NF
|
Facility
IP
|
$67.17
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
41642573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.58 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.58
|
|
|
CASPOFUNGIN 50 MG INJ - NF
|
Facility
OP
|
$67.17
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
41652573
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$43.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.25
|
| Rate for Payer: Aetna Government |
$6.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Group Health Inc Commercial |
$33.58
|
| Rate for Payer: Group Health Inc Medicare |
$23.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.03
|
| Rate for Payer: SOMOS Essential |
$7.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.66
|
|
|
CASPOFUNGIN 70 MG INJ - NF
|
Facility
OP
|
$49.55
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
41642574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$32.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.25
|
| Rate for Payer: Aetna Government |
$6.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Group Health Inc Commercial |
$24.78
|
| Rate for Payer: Group Health Inc Medicare |
$17.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.03
|
| Rate for Payer: SOMOS Essential |
$7.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.21
|
|
|
CASPOFUNGIN 70 MG INJ - NF
|
Facility
OP
|
$49.55
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
41652574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$32.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.25
|
| Rate for Payer: Aetna Government |
$6.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.76
|
| Rate for Payer: Group Health Inc Commercial |
$24.78
|
| Rate for Payer: Group Health Inc Medicare |
$17.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.62
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$7.03
|
| Rate for Payer: SOMOS Essential |
$7.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.21
|
|
|
CASPOFUNGIN 70 MG INJ - NF
|
Facility
IP
|
$49.55
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
41642574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.78 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.78
|
|
|
CASPOFUNGIN 70 MG INJ - NF
|
Facility
IP
|
$49.55
|
|
|
Service Code
|
HCPCS J0637
|
| Hospital Charge Code |
41652574
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.78 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.78
|
|
|
CASTING SAW
|
Facility
OP
|
$2,462.63
|
|
| Hospital Charge Code |
64903690
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$861.92 |
| Max. Negotiated Rate |
$1,970.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,354.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,231.32
|
| Rate for Payer: Aetna Government |
$1,231.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,970.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,674.59
|
| Rate for Payer: Group Health Inc Commercial |
$1,231.32
|
| Rate for Payer: Group Health Inc Medicare |
$861.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,231.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,231.32
|
|
|
CASTING SYS 4 EZ
|
Facility
OP
|
$2,685.38
|
|
| Hospital Charge Code |
64903688
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$939.88 |
| Max. Negotiated Rate |
$2,148.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,476.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,342.69
|
| Rate for Payer: Aetna Government |
$1,342.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,148.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,826.06
|
| Rate for Payer: Group Health Inc Commercial |
$1,342.69
|
| Rate for Payer: Group Health Inc Medicare |
$939.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,342.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,342.69
|
|
|
CASTING SYSTM 3 W/2REG BOOTS
|
Facility
OP
|
$268.54
|
|
| Hospital Charge Code |
64905486
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$93.99 |
| Max. Negotiated Rate |
$214.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$147.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.27
|
| Rate for Payer: Aetna Government |
$134.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$214.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$182.61
|
| Rate for Payer: Group Health Inc Commercial |
$134.27
|
| Rate for Payer: Group Health Inc Medicare |
$93.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$134.27
|
|
|
CASTOR OIL 60 ML
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41653489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
CASTOR OIL 60 ML
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41643489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
CAST POST AND CORE IN ADDITION TO
|
Facility
OP
|
$312.50
|
|
|
Service Code
|
HCPCS D2952
|
| Hospital Charge Code |
42300655
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.25 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$171.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$156.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
|
CATARACT EXTRACTION
|
Facility
OP
|
$6,123.70
|
|
|
Service Code
|
HCPCS 66940
|
| Hospital Charge Code |
40072465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$829.07 |
| Max. Negotiated Rate |
$3,061.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,694.88
|
| Rate for Payer: Aetna Government |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,694.88
|
| 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 |
$2,694.88
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$829.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,290.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,398.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,694.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,398.44
|
| Rate for Payer: Group Health Inc Commercial |
$2,694.88
|
| Rate for Payer: Group Health Inc Medicare |
$2,694.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,061.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,694.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$921.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,290.65
|
| Rate for Payer: Healthfirst QHP |
$2,694.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,694.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,155.90
|
| Rate for Payer: Wellcare Medicare |
$2,560.14
|
|
|
CATARACT SURG W/IOL 1 STAGE
|
Facility
OP
|
$6,123.70
|
|
|
Service Code
|
HCPCS 66984
|
| Hospital Charge Code |
30302030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,694.88
|
| Rate for Payer: Aetna Government |
$2,694.88
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,694.88
|
| 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 |
$2,694.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$574.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,290.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,398.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,694.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,398.44
|
| 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 |
$3,061.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,694.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$638.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,290.65
|
| Rate for Payer: Healthfirst QHP |
$2,694.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,694.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,694.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,155.90
|
| Rate for Payer: Wellcare Medicare |
$2,560.14
|
|
|
CATARACT SURG W/IOL 1 STAGE
|
Facility
OP
|
$6,123.70
|
|
|
Service Code
|
HCPCS 66984
|
| Hospital Charge Code |
40073277
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$574.45 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,694.88
|
| Rate for Payer: Aetna Government |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Cash Price |
$2,694.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,694.88
|
| 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 |
$2,694.88
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$574.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,290.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,398.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,694.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,398.44
|
| Rate for Payer: Group Health Inc Commercial |
$2,694.88
|
| Rate for Payer: Group Health Inc Medicare |
$2,694.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,061.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,694.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$638.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,290.65
|
| Rate for Payer: Healthfirst QHP |
$2,694.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,694.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,694.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,155.90
|
| Rate for Payer: Wellcare Medicare |
$2,560.14
|
|
|
CATECHOLAMINES, PLASMA
|
Facility
OP
|
$63.13
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
40609049
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$40.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.25
|
| Rate for Payer: Aetna Government |
$25.25
|
| Rate for Payer: Cash Price |
$25.25
|
| Rate for Payer: Cash Price |
$25.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.25
|
| Rate for Payer: EmblemHealth Commercial |
$25.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.47
|
| Rate for Payer: Group Health Inc Commercial |
$25.25
|
| Rate for Payer: Group Health Inc Medicare |
$25.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.25
|
| Rate for Payer: Healthfirst QHP |
$25.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Wellcare Medicare |
$22.72
|
|
|
CATECHOLAMINES,UR.,FREE,24 HR
|
Facility
OP
|
$63.13
|
|
|
Service Code
|
HCPCS 82384
|
| Hospital Charge Code |
40609050
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$40.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.25
|
| Rate for Payer: Aetna Government |
$25.25
|
| Rate for Payer: Cash Price |
$25.25
|
| Rate for Payer: Cash Price |
$25.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.25
|
| Rate for Payer: EmblemHealth Commercial |
$25.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.47
|
| Rate for Payer: Group Health Inc Commercial |
$25.25
|
| Rate for Payer: Group Health Inc Medicare |
$25.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.25
|
| Rate for Payer: Healthfirst QHP |
$25.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Wellcare Medicare |
$22.72
|
|
|
CATH 014 3.0X40MM 150CM
|
Facility
OP
|
$600.00
|
|
| Hospital Charge Code |
64906780
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$480.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$330.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$300.00
|
| Rate for Payer: Aetna Government |
$300.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$480.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$408.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$210.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
|
|
CATH 14.5X19CM CUFFED DUAL LUMEN
|
Facility
IP
|
$836.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40209086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.00 |
| Max. Negotiated Rate |
$418.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$418.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$418.00
|
|
|
CATH 14.5X19CM CUFFED DUAL LUMEN
|
Facility
OP
|
$836.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40209086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$459.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$418.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$480.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$877.80
|
| Rate for Payer: Group Health Inc Commercial |
$418.00
|
| Rate for Payer: Group Health Inc Medicare |
$292.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$418.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$418.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$543.40
|
|
|
CATH < 400.00
|
Facility
IP
|
$357.37
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40203024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$178.68 |
| Max. Negotiated Rate |
$178.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.68
|
|
|
CATH < 400.00
|
Facility
OP
|
$357.37
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
40203024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$375.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$178.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$205.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$375.24
|
| Rate for Payer: Group Health Inc Commercial |
$178.68
|
| Rate for Payer: Group Health Inc Medicare |
$125.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$232.29
|
|
