|
BONE SUBSTITUTE
|
Facility
|
OP
|
$6,300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40009115
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$6,615.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,465.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$3,780.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,150.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,622.50
|
| Rate for Payer: EmblemHealth Commercial |
$3,150.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,615.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,150.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,205.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,150.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,150.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,095.00
|
|
|
BONE SUBSTITUTE
|
Facility
|
IP
|
$822.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40203151
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.30 |
| Max. Negotiated Rate |
$411.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$411.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$411.30
|
|
|
BONE VOID FILLER
|
Facility
|
IP
|
$2,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,038.00 |
| Max. Negotiated Rate |
$1,038.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,038.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,038.00
|
|
|
BONE VOID FILLER
|
Facility
|
OP
|
$2,076.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$2,179.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,141.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,245.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,038.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,193.70
|
| Rate for Payer: EmblemHealth Commercial |
$1,038.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,179.80
|
| Rate for Payer: Group Health Inc Commercial |
$1,038.00
|
| Rate for Payer: Group Health Inc Medicare |
$726.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,038.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,038.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,349.40
|
|
|
BONNEY TISSUE FORCEP
|
Facility
|
OP
|
$50.28
|
|
| Hospital Charge Code |
64903644
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$40.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.14
|
| Rate for Payer: Aetna Government |
$25.14
|
| Rate for Payer: Brighton Health Commercial |
$37.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.19
|
| Rate for Payer: Group Health Inc Commercial |
$25.14
|
| Rate for Payer: Group Health Inc Medicare |
$17.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.14
|
|
|
BONSTON SCI ACCOLADE EL DR L321
|
Facility
|
OP
|
$13,300.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
66572892
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$13,965.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7,315.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.42
|
| Rate for Payer: Aetna Government |
$275.42
|
| Rate for Payer: Brighton Health Commercial |
$7,980.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,650.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,647.50
|
| Rate for Payer: EmblemHealth Commercial |
$6,650.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,965.00
|
| Rate for Payer: Group Health Inc Commercial |
$6,650.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,655.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,650.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,650.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,645.00
|
|
|
BOOTS BUCKS TRACTION FULL
|
Facility
|
OP
|
$47.17
|
|
| Hospital Charge Code |
64901795
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$37.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.58
|
| Rate for Payer: Aetna Government |
$23.58
|
| Rate for Payer: Brighton Health Commercial |
$35.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.08
|
| Rate for Payer: Group Health Inc Commercial |
$23.58
|
| Rate for Payer: Group Health Inc Medicare |
$16.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.58
|
|
|
BOOT SUSPENSION HEELLIFT
|
Facility
|
OP
|
$64.80
|
|
| Hospital Charge Code |
64903162
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$51.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.40
|
| Rate for Payer: Aetna Government |
$32.40
|
| Rate for Payer: Brighton Health Commercial |
$48.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.06
|
| Rate for Payer: Group Health Inc Commercial |
$32.40
|
| Rate for Payer: Group Health Inc Medicare |
$22.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.40
|
|
|
BOOT TCC-EZ LG
|
Facility
|
OP
|
$200.48
|
|
| Hospital Charge Code |
64903736
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.17 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.24
|
| Rate for Payer: Aetna Government |
$100.24
|
| Rate for Payer: Brighton Health Commercial |
$150.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.33
|
| Rate for Payer: Group Health Inc Commercial |
$100.24
|
| Rate for Payer: Group Health Inc Medicare |
$70.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.24
|
|
|
BOOT TCC-EZ XLG
|
Facility
|
OP
|
$210.38
|
|
| Hospital Charge Code |
64903734
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.63 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.19
|
| Rate for Payer: Aetna Government |
$105.19
|
| Rate for Payer: Brighton Health Commercial |
$157.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.06
|
| Rate for Payer: Group Health Inc Commercial |
$105.19
|
| Rate for Payer: Group Health Inc Medicare |
$73.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.19
|
|
|
BOOT TRACTION BUCKS UNIVERSAL
|
Facility
|
OP
|
$48.70
|
|
| Hospital Charge Code |
64901738
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$38.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.35
|
| Rate for Payer: Aetna Government |
$24.35
|
| Rate for Payer: Brighton Health Commercial |
$36.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.12
|
| Rate for Payer: Group Health Inc Commercial |
$24.35
|
| Rate for Payer: Group Health Inc Medicare |
$17.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.35
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR [123070]
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
25021024410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.96
|
| Rate for Payer: Aetna Government |
$1.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$63.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$67.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.96
|
| Rate for Payer: EmblemHealth Commercial |
$1.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$1.96
|
| Rate for Payer: Group Health Inc Medicare |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.22
|
| Rate for Payer: Healthfirst Essential Plan |
$106.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.67
|
| Rate for Payer: Healthfirst QHP |
$47.22
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$47.22
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.57
|
| Rate for Payer: Wellcare Medicare |
$1.86
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR [123070]
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
00143909801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.96
|
| Rate for Payer: Aetna Government |
$1.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.96
|
| Rate for Payer: EmblemHealth Commercial |
$1.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$1.96
|
| Rate for Payer: Group Health Inc Medicare |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.22
|
| Rate for Payer: Healthfirst Essential Plan |
$106.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.67
|
| Rate for Payer: Healthfirst QHP |
$47.22
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$47.22
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.57
|
| Rate for Payer: Wellcare Medicare |
$1.86
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR [123070]
|
Facility
|
OP
|
$1,923.60
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
63020004901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,057.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.96
|
| Rate for Payer: Aetna Government |
$1.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$1,442.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,538.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,308.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.96
|
| Rate for Payer: EmblemHealth Commercial |
$1.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$1.96
|
| Rate for Payer: Group Health Inc Medicare |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.22
|
| Rate for Payer: Healthfirst Essential Plan |
$106.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.67
|
| Rate for Payer: Healthfirst QHP |
$47.22
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$47.22
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,250.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.57
|
| Rate for Payer: Wellcare Medicare |
$1.86
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR [123070]
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
50742048401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$198.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.96
|
| Rate for Payer: Aetna Government |
$1.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$270.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$288.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$244.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.96
|
| Rate for Payer: EmblemHealth Commercial |
$1.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$1.96
|
| Rate for Payer: Group Health Inc Medicare |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.22
|
| Rate for Payer: Healthfirst Essential Plan |
$106.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.67
|
| Rate for Payer: Healthfirst QHP |
$47.22
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$47.22
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$234.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.57
|
| Rate for Payer: Wellcare Medicare |
$1.86
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR [123070]
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
70860022510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.96
|
| Rate for Payer: Aetna Government |
$1.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$180.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.96
|
| Rate for Payer: EmblemHealth Commercial |
$1.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$1.96
|
| Rate for Payer: Group Health Inc Medicare |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.22
|
| Rate for Payer: Healthfirst Essential Plan |
$106.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.67
|
| Rate for Payer: Healthfirst QHP |
$47.22
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$47.22
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$156.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.57
|
| Rate for Payer: Wellcare Medicare |
$1.86
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR [123070]
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
43598042660
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.96
|
| Rate for Payer: Aetna Government |
$1.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$225.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$240.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$204.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.96
|
| Rate for Payer: EmblemHealth Commercial |
$1.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$1.96
|
| Rate for Payer: Group Health Inc Medicare |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.22
|
| Rate for Payer: Healthfirst Essential Plan |
$106.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.67
|
| Rate for Payer: Healthfirst QHP |
$47.22
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$47.22
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$195.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.57
|
| Rate for Payer: Wellcare Medicare |
$1.86
|
|
|
BORTEZOMIB 3.5 MG IJ SOLR [123070]
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
71288011810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.96
|
| Rate for Payer: Aetna Government |
$1.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$37.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.96
|
| Rate for Payer: EmblemHealth Commercial |
$1.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$1.96
|
| Rate for Payer: Group Health Inc Medicare |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.22
|
| Rate for Payer: Healthfirst Essential Plan |
$106.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.67
|
| Rate for Payer: Healthfirst QHP |
$47.22
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.07
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$47.22
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.57
|
| Rate for Payer: Wellcare Medicare |
$1.86
|
|
|
BORTEZOMIB 3.5 MG INJ
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
41653013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.96
|
| Rate for Payer: Aetna Government |
$1.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$91.20
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$76.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$87.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.96
|
| Rate for Payer: EmblemHealth Commercial |
$1.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$1.96
|
| Rate for Payer: Group Health Inc Medicare |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.22
|
| Rate for Payer: Healthfirst Essential Plan |
$106.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.67
|
| Rate for Payer: Healthfirst QHP |
$47.22
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$47.22
|
| Rate for Payer: United Healthcare Commercial |
$9.01
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.57
|
| Rate for Payer: Wellcare Medicare |
$1.86
|
|
|
BORTEZOMIB 3.5 MG INJ
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
41653013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.00
|
|
|
BORTEZOMIB 3.5 MG INJ
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
41643013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$4,722.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.96
|
| Rate for Payer: Aetna Government |
$1.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$106.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$106.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$47.22
|
| Rate for Payer: Amida Care Medicaid |
$47.22
|
| Rate for Payer: Brighton Health Commercial |
$91.20
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$76.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$87.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.96
|
| Rate for Payer: EmblemHealth Commercial |
$1.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,722.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$47.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49.58
|
| Rate for Payer: Group Health Inc Commercial |
$1.96
|
| Rate for Payer: Group Health Inc Medicare |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.22
|
| Rate for Payer: Healthfirst Essential Plan |
$106.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.67
|
| Rate for Payer: Healthfirst QHP |
$47.22
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$47.22
|
| Rate for Payer: SOMOS Essential |
$47.22
|
| Rate for Payer: United Healthcare Commercial |
$9.01
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$106.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51.94
|
| Rate for Payer: United Healthcare Medicaid |
$47.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$98.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.57
|
| Rate for Payer: Wellcare Medicare |
$1.86
|
|
|
BORTEZOMIB 3.5 MG INJ
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
41643013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Cash Price |
$1.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.00
|
|
|
BOS POLARIS UL 6F 2MM X 26CM
|
Facility
|
OP
|
$405.65
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
40008267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$425.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$223.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.97
|
| Rate for Payer: Aetna Government |
$2.97
|
| Rate for Payer: Brighton Health Commercial |
$243.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$202.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$233.25
|
| Rate for Payer: EmblemHealth Commercial |
$202.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$425.93
|
| Rate for Payer: Group Health Inc Commercial |
$202.82
|
| Rate for Payer: Group Health Inc Medicare |
$141.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$202.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$263.67
|
|
|
BOS POLARIS UL 6F 2MM X 26CM
|
Facility
|
IP
|
$405.65
|
|
|
Service Code
|
HCPCS C1758
|
| Hospital Charge Code |
40008267
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.82 |
| Max. Negotiated Rate |
$202.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$202.82
|
|
|
BOS.SCI. 5FR IMAGER
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
40208128
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$63.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.00
|
|
