|
CALCIUM GLUCONATE 10 % IV SOLN [1312]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
63323036001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
|
|
CALCIUM GLUCONATE 10 % IV SOLN [1312]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
00143918025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.13
|
| Rate for Payer: Aetna Government |
$4.13
|
| Rate for Payer: Brighton Health Commercial |
$0.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.69
|
| Rate for Payer: EmblemHealth Commercial |
$0.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
CALCIUM GLUCONATE 10 % IV SOLN [1312]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
63323036019
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
|
|
CALCIUM GLUCONATE 10 % IV SOLN [1312]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
75834017119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
|
|
CALCIUM GLUCONATE 10 % IV SOLN [1312]
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
00143918025
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
|
|
CALCIUM GLUCONATE 10 % IV SOLN [1312]
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
75834017119
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.13
|
| Rate for Payer: Aetna Government |
$4.13
|
| Rate for Payer: Brighton Health Commercial |
$0.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.69
|
| Rate for Payer: EmblemHealth Commercial |
$0.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.60
|
| Rate for Payer: Group Health Inc Medicare |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.78
|
|
|
CALCIUM GLUCONATE 500 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640649
|
|
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
|
|
|
CALCIUM GLUCONATE 500 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650649
|
|
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
|
|
|
CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN [166340]
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
65219016201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
|
|
CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN [166340]
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
44567062024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
|
|
CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN [166340]
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
65219016201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.06
|
| Rate for Payer: EmblemHealth Commercial |
$0.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.05
|
| Rate for Payer: Healthfirst QHP |
$0.06
|
| Rate for Payer: Humana Medicare |
$0.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.05
|
|
|
CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN [166340]
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
44567062001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
|
|
CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN [166340]
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
44567062001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.11
|
| Rate for Payer: EmblemHealth Commercial |
$0.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.09
|
| Rate for Payer: Healthfirst QHP |
$0.11
|
| Rate for Payer: Humana Medicare |
$0.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.09
|
|
|
CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN [166340]
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
44567062024
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.06
|
| Rate for Payer: EmblemHealth Commercial |
$0.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.05
|
| Rate for Payer: Healthfirst QHP |
$0.06
|
| Rate for Payer: Humana Medicare |
$0.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.05
|
|
|
CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN [168991]
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
44567062124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
|
|
CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN [168991]
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
44567062124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.11
|
| Rate for Payer: EmblemHealth Commercial |
$0.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.09
|
| Rate for Payer: Healthfirst QHP |
$0.11
|
| Rate for Payer: Humana Medicare |
$0.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.09
|
|
|
CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN [168991]
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
44567062101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
|
|
CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN [168991]
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J0613
|
| Hospital Charge Code |
44567062101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.11
|
| Rate for Payer: EmblemHealth Commercial |
$0.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.09
|
| Rate for Payer: Healthfirst QHP |
$0.11
|
| Rate for Payer: Humana Medicare |
$0.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.09
|
|
|
CALCIUM, IONIZED
|
Facility
|
OP
|
$34.20
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
40602466
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.68
|
| Rate for Payer: Aetna Government |
$13.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.58
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.58
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.58
|
| Rate for Payer: Brighton Health Commercial |
$25.65
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.68
|
| Rate for Payer: EmblemHealth Commercial |
$13.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.18
|
| Rate for Payer: Group Health Inc Commercial |
$13.68
|
| Rate for Payer: Group Health Inc Medicare |
$13.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.68
|
| Rate for Payer: Healthfirst QHP |
$13.68
|
| Rate for Payer: Humana Medicare |
$13.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.68
|
| Rate for Payer: United Healthcare Commercial |
$17.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.94
|
| Rate for Payer: Wellcare Medicare |
$12.31
|
|
|
CALCIUM, IONIZED
|
Facility
|
IP
|
$34.20
|
|
|
Service Code
|
HCPCS 82330
|
| Hospital Charge Code |
40602466
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$13.68
|
|
|
CALDWELL LUC
|
Facility
|
IP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 31030
|
| Hospital Charge Code |
40108810
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,772.21
|
|
|
CALDWELL LUC
|
Facility
|
OP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 31030
|
| Hospital Charge Code |
40108810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$11,018.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,740.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,740.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,740.55
|
| Rate for Payer: Brighton Health Commercial |
$11,018.29
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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 |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Humana Medicare |
$6,907.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
CAL GLUC 2000/MGD5W 100ML-20MG U
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
41647158
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
CAL GLUC 2000MG/D5W 100ML-20MG U
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
41657158
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
CAL GLUC 2000MG NS 100ML-20MG/ML
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
41647162
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Brighton Health Commercial |
$4.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
