|
CHILDHOOD ALLERGY PROFILE+IGE
|
Facility
OP
|
$41.15
|
|
|
Service Code
|
HCPCS 82785
|
| Hospital Charge Code |
40609077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.17 |
| Max. Negotiated Rate |
$26.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.46
|
| Rate for Payer: Aetna Government |
$16.46
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.46
|
| Rate for Payer: EmblemHealth Commercial |
$16.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.65
|
| Rate for Payer: Group Health Inc Commercial |
$16.46
|
| Rate for Payer: Group Health Inc Medicare |
$16.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.46
|
| Rate for Payer: Healthfirst QHP |
$16.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.17
|
| Rate for Payer: Wellcare Medicare |
$14.81
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
IP
|
$636,236.59
|
|
|
Service Code
|
MS-DRG 018
|
| Min. Negotiated Rate |
$240,981.47 |
| Max. Negotiated Rate |
$636,236.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$543,245.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$518,239.73
|
| Rate for Payer: Aetna Government |
$518,239.73
|
| Rate for Payer: Brighton Health Commercial |
$534,219.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$528,604.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$636,236.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$525,049.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$492,327.74
|
| Rate for Payer: EmblemHealth Commercial |
$315,926.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$518,239.73
|
| Rate for Payer: Group Health Inc Commercial |
$518,239.73
|
| Rate for Payer: Group Health Inc Medicare |
$518,239.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$518,239.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240,981.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$518,239.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$518,239.73
|
| Rate for Payer: Wellcare Medicare |
$492,327.74
|
|
|
CHIN PLATE 4MM
|
Facility
IP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.00
|
|
|
CHIN PLATE 4MM
|
Facility
OP
|
$414.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200074
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$227.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$207.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$434.70
|
| Rate for Payer: Group Health Inc Commercial |
$207.00
|
| Rate for Payer: Group Health Inc Medicare |
$144.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$269.10
|
|
|
CHIN PLATE 6MM
|
Facility
OP
|
$380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$218.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$399.00
|
| Rate for Payer: Group Health Inc Commercial |
$190.00
|
| Rate for Payer: Group Health Inc Medicare |
$133.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.00
|
|
|
CHIN PLATE 6MM
|
Facility
OP
|
$580.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$609.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$319.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$290.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$333.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$609.63
|
| Rate for Payer: Group Health Inc Commercial |
$290.30
|
| Rate for Payer: Group Health Inc Medicare |
$203.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$377.39
|
|
|
CHIN PLATE 6MM
|
Facility
IP
|
$580.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200706
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$290.30 |
| Max. Negotiated Rate |
$290.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$290.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$290.30
|
|
|
CHIN PLATE 6MM
|
Facility
IP
|
$380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200076
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.00
|
|
|
CHIN PLT 6MM
|
Facility
OP
|
$380.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$218.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$399.00
|
| Rate for Payer: Group Health Inc Commercial |
$190.00
|
| Rate for Payer: Group Health Inc Medicare |
$133.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.00
|
|
|
CHIN PLT 6MM
|
Facility
IP
|
$380.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209728
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$190.00
|
|
|
CHIN PLT 8MM
|
Facility
OP
|
$608.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$69.35 |
| Max. Negotiated Rate |
$638.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$334.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$69.35
|
| Rate for Payer: Aetna Government |
$69.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$304.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$349.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$638.40
|
| Rate for Payer: Group Health Inc Commercial |
$304.00
|
| Rate for Payer: Group Health Inc Medicare |
$212.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$304.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$304.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$395.20
|
|
|
CHIN PLT 8MM
|
Facility
IP
|
$608.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
40209729
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$304.00 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$304.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$304.00
|
|
|
CHLAMYDIA ANTIBODIES, IGG
|
Facility
OP
|
$29.55
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
40729353
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.82
|
| Rate for Payer: Aetna Government |
$11.82
|
| Rate for Payer: Cash Price |
$11.82
|
| Rate for Payer: Cash Price |
$11.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.82
|
| Rate for Payer: EmblemHealth Commercial |
$11.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.52
|
| Rate for Payer: Group Health Inc Commercial |
$11.82
|
| Rate for Payer: Group Health Inc Medicare |
$11.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.82
|
| Rate for Payer: Healthfirst QHP |
$11.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.46
|
| Rate for Payer: Wellcare Medicare |
$10.64
|
|
|
CHLAMYDIA/GC AMPLIFICATION
|
Facility
OP
|
$87.73
|
|
|
Service Code
|
HCPCS 87491
|
| Hospital Charge Code |
40619197
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$55.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Cash Price |
$35.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.07
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
CHLAMYDIA IGM ANTIBODY
|
Facility
OP
|
$31.70
|
|
|
Service Code
|
HCPCS 86632
|
| Hospital Charge Code |
40729456
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$20.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.68
|
| Rate for Payer: Aetna Government |
$12.68
|
| Rate for Payer: Cash Price |
$12.68
|
| Rate for Payer: Cash Price |
$12.68
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.68
|
| Rate for Payer: EmblemHealth Commercial |
$12.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.29
|
| Rate for Payer: Group Health Inc Commercial |
$12.68
|
| Rate for Payer: Group Health Inc Medicare |
$12.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.68
|
| Rate for Payer: Healthfirst QHP |
$12.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.14
|
| Rate for Payer: Wellcare Medicare |
$11.41
|
|
|
CHLAMYDIA SPECIES AB, IGG
|
Facility
OP
|
$29.55
|
|
|
Service Code
|
HCPCS 86631
|
| Hospital Charge Code |
40728121
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$18.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.82
|
| Rate for Payer: Aetna Government |
$11.82
|
| Rate for Payer: Cash Price |
$11.82
|
| Rate for Payer: Cash Price |
$11.82
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.82
|
| Rate for Payer: EmblemHealth Commercial |
$11.82
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.82
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.52
|
| Rate for Payer: Group Health Inc Commercial |
$11.82
|
| Rate for Payer: Group Health Inc Medicare |
$11.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.82
|
| Rate for Payer: Healthfirst QHP |
$11.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.46
|
| Rate for Payer: Wellcare Medicare |
$10.64
|
|
|
CHLAMYDIA TRACHOMATIS CULTURE
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
HCPCS 87110
|
| Hospital Charge Code |
40619188
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$31.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.60
|
| Rate for Payer: Aetna Government |
$19.60
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.34
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.60
|
| Rate for Payer: EmblemHealth Commercial |
$19.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.44
|
| Rate for Payer: Group Health Inc Commercial |
$19.60
|
| Rate for Payer: Group Health Inc Medicare |
$19.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.60
|
| Rate for Payer: Healthfirst QHP |
$19.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.68
|
| Rate for Payer: Wellcare Medicare |
$17.64
|
|
|
CHLORAL HYDRATE 100 MG/ML SYRUP NEONATAL
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650715
|
|
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: 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
|
|
|
CHLORAL HYDRATE 100 MG/ML SYRUP NEONATAL
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640715
|
|
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: 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
|
|
|
CHLORAL HYDRATE 500 MG/5 ML SYRUP UDC
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41652357
|
|
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: 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
|
|
|
CHLORAL HYDRATE 500 MG/5 ML SYRUP UDC
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41642357
|
|
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: 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
|
|
|
CHLORAMBUCIL 2 MG TAB
|
Facility
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41654054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
CHLORAMBUCIL 2 MG TAB
|
Facility
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41644054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.50
|
| Rate for Payer: Aetna Government |
$3.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.02
|
| Rate for Payer: Group Health Inc Commercial |
$3.50
|
| Rate for Payer: Group Health Inc Medicare |
$2.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.55
|
|
|
CHLORAMBUCIL 2 MG TAB
|
Facility
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41644054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
|
|
CHLORAMBUCIL 2 MG TAB
|
Facility
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
41654054
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.50
|
|
