|
CARD STERIL CONTAINER
|
Facility
|
OP
|
$0.16
|
|
| Hospital Charge Code |
64903831
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
|
|
CARD STERIL INDICATOR RCRD
|
Facility
|
OP
|
$0.26
|
|
| Hospital Charge Code |
64903829
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
|
|
CAREGIVER DEM TRAINED
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G2185
|
| Hospital Charge Code |
30300313
|
|
Hospital Revenue Code
|
929
|
| Max. Negotiated Rate |
$94.00 |
| 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 |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
|
|
CARE MGMT SVC BHVL HLTH COND
|
Facility
|
IP
|
$54.63
|
|
|
Service Code
|
HCPCS 99484
|
| Hospital Charge Code |
30300252
|
|
Hospital Revenue Code
|
900
|
| Rate for Payer: Cash Price |
$33.18
|
|
|
CARE MGMT SVC BHVL HLTH COND
|
Facility
|
OP
|
$54.63
|
|
|
Service Code
|
HCPCS 99484
|
| Hospital Charge Code |
30300252
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$23.23 |
| Max. Negotiated Rate |
$43.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.18
|
| Rate for Payer: Aetna Government |
$33.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$23.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$23.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23.23
|
| Rate for Payer: Brighton Health Commercial |
$40.97
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.18
|
| Rate for Payer: EmblemHealth Commercial |
$33.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$29.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29.53
|
| Rate for Payer: Group Health Inc Commercial |
$33.18
|
| Rate for Payer: Group Health Inc Medicare |
$33.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28.20
|
| Rate for Payer: Healthfirst QHP |
$33.18
|
| Rate for Payer: Humana Medicare |
$33.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$33.18
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.18
|
| Rate for Payer: United Healthcare Commercial |
$27.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26.54
|
| Rate for Payer: Wellcare Medicare |
$31.52
|
|
|
CARE OF MISCARRIAGE
|
Facility
|
OP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
40054243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$5,674.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,615.39
|
| Rate for Payer: Aetna Government |
$3,615.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,530.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,530.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,530.77
|
| Rate for Payer: Brighton Health Commercial |
$5,674.60
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Cash Price |
$3,615.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,615.39
|
| 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 |
$3,615.39
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,073.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,217.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,615.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,217.70
|
| Rate for Payer: Group Health Inc Commercial |
$3,615.39
|
| Rate for Payer: Group Health Inc Medicare |
$3,615.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,615.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,073.08
|
| Rate for Payer: Healthfirst QHP |
$3,615.39
|
| Rate for Payer: Humana Medicare |
$3,687.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,615.39
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,615.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,615.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,892.31
|
| Rate for Payer: Wellcare Medicare |
$3,434.62
|
|
|
CARE OF MISCARRIAGE
|
Facility
|
IP
|
$7,566.13
|
|
|
Service Code
|
HCPCS 59820
|
| Hospital Charge Code |
40054243
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,615.39
|
|
|
CARFILZOMIB 30MG INJECTION
|
Facility
|
OP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41659595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$55.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.08
|
| Rate for Payer: Aetna Government |
$47.08
|
| Rate for Payer: Brighton Health Commercial |
$51.21
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.08
|
| Rate for Payer: EmblemHealth Commercial |
$47.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.08
|
| Rate for Payer: Group Health Inc Commercial |
$47.08
|
| Rate for Payer: Group Health Inc Medicare |
$47.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.02
|
| Rate for Payer: Humana Medicare |
$48.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.08
|
| Rate for Payer: United Healthcare Commercial |
$45.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.67
|
| Rate for Payer: Wellcare Medicare |
$44.73
|
|
|
CARFILZOMIB 30MG INJECTION
|
Facility
|
OP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41649595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$55.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.08
|
| Rate for Payer: Aetna Government |
$47.08
|
| Rate for Payer: Brighton Health Commercial |
$51.21
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.08
|
| Rate for Payer: EmblemHealth Commercial |
$47.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.08
|
| Rate for Payer: Group Health Inc Commercial |
$47.08
|
| Rate for Payer: Group Health Inc Medicare |
$47.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.02
|
| Rate for Payer: Humana Medicare |
$48.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.08
|
| Rate for Payer: United Healthcare Commercial |
$45.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.67
|
| Rate for Payer: Wellcare Medicare |
$44.73
|
|
|
CARFILZOMIB 30MG INJECTION
|
Facility
|
IP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41659595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
|
|
CARFILZOMIB 30MG INJECTION
|
Facility
|
IP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41649595
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
|
|
CARFILZOMIB 30 MG IV SOLR [132744]
|
Facility
|
IP
|
$1,876.90
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
76075010201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.45 |
| Max. Negotiated Rate |
$938.45 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$938.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$938.45
|
|
|
CARFILZOMIB 30 MG IV SOLR [132744]
|
Facility
|
OP
|
$1,876.90
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
76075010201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$1,219.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,032.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.08
|
| Rate for Payer: Aetna Government |
$47.08
|
| Rate for Payer: Brighton Health Commercial |
$1,126.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$938.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,079.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.08
|
| Rate for Payer: EmblemHealth Commercial |
$938.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.08
|
| Rate for Payer: Group Health Inc Commercial |
$47.08
|
| Rate for Payer: Group Health Inc Medicare |
$47.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$938.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.02
|
| Rate for Payer: Humana Medicare |
$48.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,219.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.67
|
|
|
CARFILZOMIB 60MG INJECTION
|
Facility
|
IP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41659593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
|
|
CARFILZOMIB 60MG INJECTION
|
Facility
|
OP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41649593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$55.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.08
|
| Rate for Payer: Aetna Government |
$47.08
|
| Rate for Payer: Brighton Health Commercial |
$51.21
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.08
|
| Rate for Payer: EmblemHealth Commercial |
$47.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.08
|
| Rate for Payer: Group Health Inc Commercial |
$47.08
|
| Rate for Payer: Group Health Inc Medicare |
$47.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.02
|
| Rate for Payer: Humana Medicare |
$48.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.08
|
| Rate for Payer: United Healthcare Commercial |
$45.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.67
|
| Rate for Payer: Wellcare Medicare |
$44.73
|
|
|
CARFILZOMIB 60MG INJECTION
|
Facility
|
OP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41659593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$55.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.08
|
| Rate for Payer: Aetna Government |
$47.08
|
| Rate for Payer: Brighton Health Commercial |
$51.21
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.08
|
| Rate for Payer: EmblemHealth Commercial |
$47.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.08
|
| Rate for Payer: Group Health Inc Commercial |
$47.08
|
| Rate for Payer: Group Health Inc Medicare |
$47.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.02
|
| Rate for Payer: Humana Medicare |
$48.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.08
|
| Rate for Payer: United Healthcare Commercial |
$45.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.67
|
| Rate for Payer: Wellcare Medicare |
$44.73
|
|
|
CARFILZOMIB 60MG INJECTION
|
Facility
|
IP
|
$85.35
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
41649593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$42.68 |
| Rate for Payer: Cash Price |
$47.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.68
|
|
|
CARFILZOMIB 60 MG IV SOLR [117047]
|
Facility
|
IP
|
$3,753.79
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
76075010101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,876.90 |
| Max. Negotiated Rate |
$1,876.90 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,876.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,876.90
|
|
|
CARFILZOMIB 60 MG IV SOLR [117047]
|
Facility
|
OP
|
$3,753.79
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
76075010101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$37.67 |
| Max. Negotiated Rate |
$2,439.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,064.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.08
|
| Rate for Payer: Aetna Government |
$47.08
|
| Rate for Payer: Brighton Health Commercial |
$2,252.27
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,876.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,158.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,876.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.08
|
| Rate for Payer: Group Health Inc Commercial |
$47.08
|
| Rate for Payer: Group Health Inc Medicare |
$47.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,876.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$40.02
|
| Rate for Payer: Humana Medicare |
$48.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,439.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.67
|
|
|
CARIES SUSCEPTIBILITY TESTS
|
Facility
|
OP
|
$66.62
|
|
|
Service Code
|
HCPCS D0425
|
| Hospital Charge Code |
42300200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$36.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.19
|
| Rate for Payer: Aetna Government |
$9.19
|
| Rate for Payer: Brighton Health Commercial |
$49.96
|
| 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: Group Health Inc Commercial |
$33.31
|
| Rate for Payer: Group Health Inc Medicare |
$23.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$33.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.31
|
|
|
CARMUSTINE 100 MG INJ
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
41640827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Cash Price |
$271.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
|
|
CARMUSTINE 100 MG INJ
|
Facility
|
IP
|
$154.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
41650827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$77.00 |
| Rate for Payer: Cash Price |
$271.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
|
|
CARMUSTINE 100 MG INJ
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
41650827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$297.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$271.46
|
| Rate for Payer: Aetna Government |
$271.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$190.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$190.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$190.03
|
| Rate for Payer: Brighton Health Commercial |
$92.40
|
| Rate for Payer: Cash Price |
$271.47
|
| Rate for Payer: Cash Price |
$271.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$271.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$77.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$271.46
|
| Rate for Payer: EmblemHealth Commercial |
$271.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$271.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$271.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$285.04
|
| Rate for Payer: Group Health Inc Commercial |
$271.46
|
| Rate for Payer: Group Health Inc Medicare |
$271.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$230.75
|
| Rate for Payer: Healthfirst QHP |
$271.46
|
| Rate for Payer: Humana Medicare |
$276.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.78
|
| Rate for Payer: SOMOS Essential |
$297.78
|
| Rate for Payer: United Healthcare Commercial |
$245.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$271.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$217.17
|
| Rate for Payer: Wellcare Medicare |
$257.89
|
|
|
CARMUSTINE 100 MG INJ
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
41640827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$297.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$271.46
|
| Rate for Payer: Aetna Government |
$271.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$190.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$190.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$190.03
|
| Rate for Payer: Brighton Health Commercial |
$92.40
|
| Rate for Payer: Cash Price |
$271.47
|
| Rate for Payer: Cash Price |
$271.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$271.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$77.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$271.46
|
| Rate for Payer: EmblemHealth Commercial |
$271.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$271.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$271.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$285.04
|
| Rate for Payer: Fidelis Medicare Advantage |
$271.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$285.04
|
| Rate for Payer: Group Health Inc Commercial |
$271.46
|
| Rate for Payer: Group Health Inc Medicare |
$271.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$230.75
|
| Rate for Payer: Healthfirst QHP |
$271.46
|
| Rate for Payer: Humana Medicare |
$276.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$271.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$297.78
|
| Rate for Payer: SOMOS Essential |
$297.78
|
| Rate for Payer: United Healthcare Commercial |
$245.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$271.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$100.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$217.17
|
| Rate for Payer: Wellcare Medicare |
$257.89
|
|
|
CARMUSTINE 100 MG IV SOLR [28911]
|
Facility
|
IP
|
$2,142.88
|
|
|
Service Code
|
HCPCS J9050
|
| Hospital Charge Code |
00781347432
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.44 |
| Max. Negotiated Rate |
$1,071.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,071.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,071.44
|
|
