|
ZOLPIDEM TARTRATE 5 MG PO TABS [11701]
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 00093007301
|
| Hospital Charge Code |
00093007301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.31
|
| Rate for Payer: Aetna Government |
$2.31
|
| Rate for Payer: Brighton Health Commercial |
$3.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.14
|
| Rate for Payer: Group Health Inc Commercial |
$2.31
|
| Rate for Payer: Group Health Inc Medicare |
$1.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.01
|
|
|
ZOLPIDEM TARTRATE 5 MG PO TABS [11701]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 68084018911
|
| Hospital Charge Code |
68084018911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.88
|
| Rate for Payer: Aetna Government |
$0.88
|
| Rate for Payer: Brighton Health Commercial |
$1.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.88
|
| Rate for Payer: Group Health Inc Medicare |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.14
|
|
|
ZOLPIDEM TARTRATE 5 MG PO TABS [11701]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 68084018901
|
| Hospital Charge Code |
68084018901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.88
|
| Rate for Payer: Aetna Government |
$0.88
|
| Rate for Payer: Brighton Health Commercial |
$1.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.88
|
| Rate for Payer: Group Health Inc Medicare |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.14
|
|
|
ZONAIR BED
|
Facility
|
OP
|
$86.47
|
|
| Hospital Charge Code |
40209110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.26 |
| Max. Negotiated Rate |
$69.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.24
|
| Rate for Payer: Aetna Government |
$43.24
|
| Rate for Payer: Brighton Health Commercial |
$64.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$69.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.80
|
| Rate for Payer: Group Health Inc Commercial |
$43.24
|
| Rate for Payer: Group Health Inc Medicare |
$30.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.24
|
|
|
ZONEAIRE 1155 W/OPT
|
Facility
|
OP
|
$99.23
|
|
| Hospital Charge Code |
40209115
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.73 |
| Max. Negotiated Rate |
$79.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.62
|
| Rate for Payer: Aetna Government |
$49.62
|
| Rate for Payer: Brighton Health Commercial |
$74.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$79.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$67.48
|
| Rate for Payer: Group Health Inc Commercial |
$49.62
|
| Rate for Payer: Group Health Inc Medicare |
$34.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.62
|
|
|
ZONISAMIDE 100 MG CAP
|
Facility
|
OP
|
$1.09
|
|
| Hospital Charge Code |
41654538
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.74
|
| Rate for Payer: Group Health Inc Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.71
|
|
|
ZONISAMIDE 100 MG CAP
|
Facility
|
OP
|
$1.09
|
|
| Hospital Charge Code |
41644538
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.55
|
| Rate for Payer: Aetna Government |
$0.55
|
| Rate for Payer: Brighton Health Commercial |
$0.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.74
|
| Rate for Payer: Group Health Inc Commercial |
$0.55
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.71
|
|
|
ZONISAMIDE 100 MG PO CAPS [27780]
|
Facility
|
OP
|
$1.72
|
|
|
Service Code
|
NDC 50268081611
|
| Hospital Charge Code |
50268081611
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.86
|
| Rate for Payer: Aetna Government |
$0.86
|
| Rate for Payer: Brighton Health Commercial |
$1.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.17
|
| Rate for Payer: Group Health Inc Commercial |
$0.86
|
| Rate for Payer: Group Health Inc Medicare |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.12
|
|
|
ZONISAMIDE 100 MG PO CAPS [27780]
|
Facility
|
OP
|
$1.72
|
|
|
Service Code
|
NDC 50268081615
|
| Hospital Charge Code |
50268081615
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.86
|
| Rate for Payer: Aetna Government |
$0.86
|
| Rate for Payer: Brighton Health Commercial |
$1.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.17
|
| Rate for Payer: Group Health Inc Commercial |
$0.86
|
| Rate for Payer: Group Health Inc Medicare |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.12
|
|
|
ZONISAMIDE 100 MG PO CAPS [27780]
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 60687023001
|
| Hospital Charge Code |
60687023001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Brighton Health Commercial |
$0.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.61
|
| Rate for Payer: Group Health Inc Commercial |
$0.45
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.59
|
|
|
ZONISAMIDE 100 MG PO CAPS [27780]
|
Facility
|
OP
|
$2.19
|
|
|
Service Code
|
NDC 69097086107
|
| Hospital Charge Code |
69097086107
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.10
|
| Rate for Payer: Aetna Government |
$1.10
|
| Rate for Payer: Brighton Health Commercial |
$1.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.49
|
| Rate for Payer: Group Health Inc Commercial |
$1.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.42
|
|
|
ZONISAMIDE 10 MG/ML SUSP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41654540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ZONISAMIDE 10 MG/ML SUSP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41644540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ZONISAMIDE 25 MG CAP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41645500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ZONISAMIDE 25 MG CAP
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41655500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ZONISAMIDE 25 MG PO CAPS [36987]
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
NDC 68462012801
|
| Hospital Charge Code |
68462012801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.37
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.36
|
|
|
ZONISAMIDE 25 MG PO CAPS [36987]
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
NDC 62756025802
|
| Hospital Charge Code |
62756025802
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.37
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.36
|
|
|
ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR [150819]
|
Facility
|
OP
|
$237.47
|
|
|
Service Code
|
HCPCS 90750
|
| Hospital Charge Code |
58160082311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.12 |
| Max. Negotiated Rate |
$14,140.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$165.25
|
| Rate for Payer: Aetna Government |
$165.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$318.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$318.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$141.40
|
| Rate for Payer: Amida Care Medicaid |
$141.40
|
| Rate for Payer: Brighton Health Commercial |
$178.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$189.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14,140.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$141.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$141.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$148.47
|
| Rate for Payer: Group Health Inc Commercial |
$118.74
|
| Rate for Payer: Group Health Inc Medicare |
$83.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$141.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.40
|
| Rate for Payer: Healthfirst Essential Plan |
$318.15
|
| Rate for Payer: Healthfirst QHP |
$141.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$141.40
|
| Rate for Payer: SOMOS Essential |
$141.40
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$318.15
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$155.54
|
| Rate for Payer: United Healthcare Medicaid |
$141.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$154.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$141.40
|
|
|
ZR ELVOW 1 VIEW
|
Facility
|
OP
|
$766.16
|
|
|
Service Code
|
HCPCS 76499 TC
|
| Hospital Charge Code |
41107502
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$73.56 |
| Max. Negotiated Rate |
$421.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.08
|
| Rate for Payer: Aetna Government |
$105.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$73.56
|
| Rate for Payer: Brighton Health Commercial |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Cash Price |
$105.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$105.08
|
| Rate for Payer: EmblemHealth Commercial |
$73.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$89.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$89.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$93.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$105.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$93.52
|
| Rate for Payer: Group Health Inc Commercial |
$94.57
|
| Rate for Payer: Group Health Inc Medicare |
$94.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$94.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$105.08
|
| Rate for Payer: Healthfirst QHP |
$105.08
|
| Rate for Payer: Humana Medicare |
$107.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$105.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$105.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.06
|
| Rate for Payer: Wellcare Medicare |
$99.83
|
|
|
ZR ELVOW 1 VIEW
|
Facility
|
IP
|
$766.16
|
|
|
Service Code
|
HCPCS 76499 TC
|
| Hospital Charge Code |
41107502
|
|
Hospital Revenue Code
|
320
|
| Rate for Payer: Cash Price |
$105.08
|
|
|
Z SCARF GUIDE
|
Facility
|
OP
|
$250.00
|
|
| Hospital Charge Code |
64905959
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.00
|
| Rate for Payer: Aetna Government |
$125.00
|
| Rate for Payer: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.00
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
|
|
ZZ 14 F X 24CM SPLIT CATH III SET
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41561878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$473.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Brighton Health Commercial |
$516.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$430.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$494.50
|
| Rate for Payer: EmblemHealth Commercial |
$430.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$903.00
|
| Rate for Payer: Group Health Inc Commercial |
$430.00
|
| Rate for Payer: Group Health Inc Medicare |
$301.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$430.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$430.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$559.00
|
|
|
ZZ 14 F X 24CM SPLIT CATH III SET
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
41561878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.00 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$430.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$430.00
|
|
|
ZZ 14 F X24CM SPLIT CATH III SET
|
Facility
|
OP
|
$860.00
|
|
| Hospital Charge Code |
41501878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$473.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$430.00
|
| Rate for Payer: Aetna Government |
$430.00
|
| Rate for Payer: Brighton Health Commercial |
$516.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$430.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$494.50
|
| Rate for Payer: EmblemHealth Commercial |
$430.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$903.00
|
| Rate for Payer: Group Health Inc Commercial |
$430.00
|
| Rate for Payer: Group Health Inc Medicare |
$301.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$430.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$430.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$559.00
|
|
|
ZZ 14 F X24CM SPLIT CATH III SET
|
Facility
|
IP
|
$860.00
|
|
| Hospital Charge Code |
41501878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.00 |
| Max. Negotiated Rate |
$430.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$430.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$430.00
|
|
