|
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
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
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
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
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: Brighton Health Commercial |
$169.82
|
| 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 |
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: Brighton Health Commercial |
$36.75
|
| 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 |
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: Brighton Health Commercial |
$36.75
|
| 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
|
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
|
OP
|
$6,509.00
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
41653249
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$748.65 |
| 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: Affinity Essential Plan 1&2 |
$748.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$748.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$748.65
|
| Rate for Payer: Brighton Health Commercial |
$3,905.40
|
| 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 Medicare Advantage |
$909.07
|
| Rate for Payer: Healthfirst QHP |
$1,069.50
|
| Rate for Payer: Humana Medicare |
$1,090.89
|
| 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: United Healthcare Commercial |
$1,937.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,069.50
|
| 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 |
$748.65 |
| 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: Affinity Essential Plan 1&2 |
$748.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$748.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$748.65
|
| Rate for Payer: Brighton Health Commercial |
$3,905.40
|
| 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 Medicare Advantage |
$909.07
|
| Rate for Payer: Healthfirst QHP |
$1,069.50
|
| Rate for Payer: Humana Medicare |
$1,090.89
|
| 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: United Healthcare Commercial |
$1,937.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,069.50
|
| 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 |
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) 200 UNIT/ACT NA SOLN [15738]
|
Facility
|
OP
|
$32.04
|
|
|
Service Code
|
NDC 60505082306
|
| Hospital Charge Code |
60505082306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$25.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.02
|
| Rate for Payer: Aetna Government |
$16.02
|
| Rate for Payer: Brighton Health Commercial |
$24.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.79
|
| Rate for Payer: Group Health Inc Commercial |
$16.02
|
| Rate for Payer: Group Health Inc Medicare |
$11.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.82
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML IJ SOLN [9347]
|
Facility
|
OP
|
$1,879.26
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
67457067502
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$748.65 |
| Max. Negotiated Rate |
$1,503.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,033.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,069.50
|
| Rate for Payer: Aetna Government |
$1,069.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$748.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$748.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$748.65
|
| Rate for Payer: Brighton Health Commercial |
$1,409.44
|
| 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 |
$1,503.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,277.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,069.50
|
| Rate for Payer: EmblemHealth Commercial |
$1,069.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$909.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$951.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,069.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$951.85
|
| 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 |
$939.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,069.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$909.07
|
| Rate for Payer: Healthfirst QHP |
$1,069.50
|
| Rate for Payer: Humana Medicare |
$1,090.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,101.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,167.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,167.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,167.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,069.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,069.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,221.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$855.60
|
| Rate for Payer: Wellcare Medicare |
$1,016.02
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML IJ SOLN [9347]
|
Facility
|
OP
|
$1,878.60
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
42023020501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$748.65 |
| Max. Negotiated Rate |
$1,502.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,033.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,069.50
|
| Rate for Payer: Aetna Government |
$1,069.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$748.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$748.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$748.65
|
| Rate for Payer: Brighton Health Commercial |
$1,408.95
|
| 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 |
$1,502.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,277.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,069.50
|
| Rate for Payer: EmblemHealth Commercial |
$1,069.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$909.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$951.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,069.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$951.85
|
| 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 |
$939.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,069.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$909.07
|
| Rate for Payer: Healthfirst QHP |
$1,069.50
|
| Rate for Payer: Humana Medicare |
$1,090.89
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1,101.74
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,167.84
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1,167.84
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1,167.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,069.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,069.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,221.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$855.60
|
| Rate for Payer: Wellcare Medicare |
$1,016.02
|
|
|
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: Brighton Health Commercial |
$74.92
|
| 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: Brighton Health Commercial |
$74.92
|
| 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 |
$18.75 |
| Max. Negotiated Rate |
$50.24 |
| 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: Affinity Essential Plan 1&2 |
$18.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$18.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18.75
|
| Rate for Payer: Brighton Health Commercial |
$50.24
|
| 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 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 Medicare Advantage |
$26.79
|
| Rate for Payer: Healthfirst QHP |
$26.79
|
| Rate for Payer: Humana Medicare |
$27.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26.79
|
| Rate for Payer: United Healthcare Commercial |
$33.92
|
| Rate for Payer: United Healthcare 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
|
|
|
CALCITONIN, SERUM
|
Facility
|
IP
|
$66.98
|
|
|
Service Code
|
HCPCS 82308
|
| Hospital Charge Code |
40609046
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$26.79
|
|
|
CALCITRATE 950MG(=200MG
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41647043
|
|
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
|
|
|
CALCITRATE 950MG(=200MG
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41657043
|
|
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
|
|
|
CALCITRIOL 0.25 MCG CAP
|
Facility
|
OP
|
$1.66
|
|
| Hospital Charge Code |
41655246
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.83
|
| Rate for Payer: Aetna Government |
$0.83
|
| Rate for Payer: Brighton Health Commercial |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.08
|
|
|
CALCITRIOL 0.25 MCG CAP
|
Facility
|
OP
|
$1.66
|
|
| Hospital Charge Code |
41645246
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.83
|
| Rate for Payer: Aetna Government |
$0.83
|
| Rate for Payer: Brighton Health Commercial |
$1.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.83
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.08
|
|
|
CALCITRIOL 0.25 MCG PO CAPS [9350]
|
Facility
|
OP
|
$0.89
|
|
|
Service Code
|
NDC 60687034501
|
| Hospital Charge Code |
60687034501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.44
|
| Rate for Payer: Aetna Government |
$0.44
|
| Rate for Payer: Brighton Health Commercial |
$0.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.60
|
| Rate for Payer: Group Health Inc Commercial |
$0.44
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.58
|
|
|
CALCITRIOL 0.25 MCG PO CAPS [9350]
|
Facility
|
OP
|
$0.89
|
|
|
Service Code
|
NDC 60687034511
|
| Hospital Charge Code |
60687034511
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.45
|
| Rate for Payer: Aetna Government |
$0.45
|
| Rate for Payer: Brighton Health Commercial |
$0.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.71
|
| 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 |
$0.31
|
| 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 |
$0.58
|
|
|
CALCITRIOL 0.25 MCG PO CAPS [9350]
|
Facility
|
OP
|
$1.28
|
|
|
Service Code
|
NDC 00054000713
|
| Hospital Charge Code |
00054000713
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.64
|
| Rate for Payer: Aetna Government |
$0.64
|
| Rate for Payer: Brighton Health Commercial |
$0.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.87
|
| Rate for Payer: Group Health Inc Commercial |
$0.64
|
| Rate for Payer: Group Health Inc Medicare |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.83
|
|
|
CALCITRIOL 0.5 MCG CAP
|
Facility
|
OP
|
$1.78
|
|
| Hospital Charge Code |
41655247
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Government |
$0.89
|
| Rate for Payer: Brighton Health Commercial |
$1.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.21
|
| Rate for Payer: Group Health Inc Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.16
|
|
|
CALCITRIOL 0.5 MCG CAP
|
Facility
|
OP
|
$1.78
|
|
| Hospital Charge Code |
41645247
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Government |
$0.89
|
| Rate for Payer: Brighton Health Commercial |
$1.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.21
|
| Rate for Payer: Group Health Inc Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.16
|
|
