|
CHLORPROMAZINE 50 MG TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41650597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
CHLORPROMAZINE 50 MG TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41640597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.70
|
| Rate for Payer: Aetna Government |
$0.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| 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
|
|
|
CHLORPROMAZINE 50 MG TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41640597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
|
|
CHLORPROMAZINE 50 MG TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS Q0161
|
| Hospital Charge Code |
41650597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.70
|
| Rate for Payer: Aetna Government |
$0.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| 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
|
|
|
CHLORTHALIDONE 25 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41651565
|
|
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
|
|
|
CHLORTHALIDONE 25 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41641565
|
|
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
|
|
|
CHOLAGIOGRAPHY TRAY
|
Facility
OP
|
$1,082.40
|
|
| Hospital Charge Code |
64902737
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$378.84 |
| Max. Negotiated Rate |
$865.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$595.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$541.20
|
| Rate for Payer: Aetna Government |
$541.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$865.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$736.03
|
| Rate for Payer: Group Health Inc Commercial |
$541.20
|
| Rate for Payer: Group Health Inc Medicare |
$378.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$541.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$541.20
|
|
|
CHOLANGIOGRAM CATHETER
|
Facility
OP
|
$122.26
|
|
| Hospital Charge Code |
40207016
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.79 |
| Max. Negotiated Rate |
$97.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61.13
|
| Rate for Payer: Aetna Government |
$61.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$83.14
|
| Rate for Payer: Group Health Inc Commercial |
$61.13
|
| Rate for Payer: Group Health Inc Medicare |
$42.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.13
|
|
|
CHOLECALCIFEROL (VITAMIN D-3) 400 UNITS
|
Facility
OP
|
$0.02
|
|
| Hospital Charge Code |
41653663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
CHOLECALCIFEROL (VITAMIN D-3) 400 UNITS
|
Facility
OP
|
$0.02
|
|
| Hospital Charge Code |
41643663
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| 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 |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
CHOLECYSTECTOMY
|
Facility
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 47562
|
| Hospital Charge Code |
40010640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$766.09 |
| Max. Negotiated Rate |
$7,320.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,672.53
|
| Rate for Payer: Aetna Government |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,672.53
|
| 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 |
$6,672.53
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$766.09
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,671.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,938.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,672.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,938.55
|
| Rate for Payer: Group Health Inc Commercial |
$6,672.53
|
| Rate for Payer: Group Health Inc Medicare |
$6,672.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,672.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$851.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,671.65
|
| Rate for Payer: Healthfirst QHP |
$6,672.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,672.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,338.02
|
| Rate for Payer: Wellcare Medicare |
$6,338.90
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC
|
Facility
IP
|
$35,421.56
|
|
|
Service Code
|
MS-DRG 415
|
| Min. Negotiated Rate |
$16,148.06 |
| Max. Negotiated Rate |
$35,421.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29,133.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,727.02
|
| Rate for Payer: Aetna Government |
$34,727.02
|
| Rate for Payer: Brighton Health Commercial |
$28,649.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,421.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34,120.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28,157.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$32,990.67
|
| Rate for Payer: EmblemHealth Commercial |
$16,942.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,727.02
|
| Rate for Payer: Group Health Inc Commercial |
$34,727.02
|
| Rate for Payer: Group Health Inc Medicare |
$34,727.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,727.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,148.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,727.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,727.02
|
| Rate for Payer: Wellcare Medicare |
$32,990.67
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC
|
Facility
IP
|
$60,876.68
|
|
|
Service Code
|
MS-DRG 414
|
| Min. Negotiated Rate |
$26,139.11 |
| Max. Negotiated Rate |
$60,876.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51,979.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56,213.13
|
| Rate for Payer: Aetna Government |
$56,213.13
|
| Rate for Payer: Brighton Health Commercial |
$51,115.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$57,337.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$60,876.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50,238.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$53,402.47
|
| Rate for Payer: EmblemHealth Commercial |
$30,228.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$56,213.13
|
| Rate for Payer: Group Health Inc Commercial |
$56,213.13
|
| Rate for Payer: Group Health Inc Medicare |
$56,213.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56,213.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26,139.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56,213.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56,213.13
|
| Rate for Payer: Wellcare Medicare |
$53,402.47
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
IP
|
$26,417.02
|
|
|
Service Code
|
MS-DRG 416
|
| Min. Negotiated Rate |
$11,483.60 |
| Max. Negotiated Rate |
$26,417.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,746.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,899.04
|
| Rate for Payer: Aetna Government |
$25,899.04
|
| Rate for Payer: Brighton Health Commercial |
$19,418.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26,417.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23,126.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,085.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,604.09
|
| Rate for Payer: EmblemHealth Commercial |
$11,483.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,899.04
|
| Rate for Payer: Group Health Inc Commercial |
$25,899.04
|
| Rate for Payer: Group Health Inc Medicare |
$25,899.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,899.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,043.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,899.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,899.04
|
| Rate for Payer: Wellcare Medicare |
$24,604.09
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH CC
|
Facility
IP
|
$36,698.82
|
|
|
Service Code
|
MS-DRG 412
|
| Min. Negotiated Rate |
$16,730.35 |
| Max. Negotiated Rate |
$36,698.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30,160.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35,979.24
|
| Rate for Payer: Aetna Government |
$35,979.24
|
| Rate for Payer: Brighton Health Commercial |
$29,659.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36,698.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35,679.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29,444.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$34,180.28
|
| Rate for Payer: EmblemHealth Commercial |
$17,540.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$35,979.24
|
| Rate for Payer: Group Health Inc Commercial |
$35,979.24
|
| Rate for Payer: Group Health Inc Medicare |
$35,979.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35,979.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,730.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35,979.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35,979.24
|
| Rate for Payer: Wellcare Medicare |
$34,180.28
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH MCC
|
Facility
IP
|
$52,504.67
|
|
|
Service Code
|
MS-DRG 411
|
| Min. Negotiated Rate |
$23,012.96 |
| Max. Negotiated Rate |
$52,504.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42,472.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49,490.24
|
| Rate for Payer: Aetna Government |
$49,490.24
|
| Rate for Payer: Brighton Health Commercial |
$41,767.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$50,480.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$52,504.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43,329.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$47,015.73
|
| Rate for Payer: EmblemHealth Commercial |
$24,700.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$49,490.24
|
| Rate for Payer: Group Health Inc Commercial |
$49,490.24
|
| Rate for Payer: Group Health Inc Medicare |
$49,490.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49,490.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23,012.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$49,490.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$49,490.24
|
| Rate for Payer: Wellcare Medicare |
$47,015.73
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC
|
Facility
IP
|
$28,827.29
|
|
|
Service Code
|
MS-DRG 413
|
| Min. Negotiated Rate |
$12,944.80 |
| Max. Negotiated Rate |
$28,827.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,259.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,262.05
|
| Rate for Payer: Aetna Government |
$28,262.05
|
| Rate for Payer: Brighton Health Commercial |
$21,889.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,827.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26,069.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,513.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,848.95
|
| Rate for Payer: EmblemHealth Commercial |
$12,944.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,262.05
|
| Rate for Payer: Group Health Inc Commercial |
$28,262.05
|
| Rate for Payer: Group Health Inc Medicare |
$28,262.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,262.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,141.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,262.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,262.05
|
| Rate for Payer: Wellcare Medicare |
$26,848.95
|
|
|
CHOLECYSTOJEJUNOSTOMY
|
Facility
OP
|
$3,683.48
|
|
|
Service Code
|
HCPCS 47740
|
| Hospital Charge Code |
40011090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,289.22 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,025.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,544.03
|
| Rate for Payer: Aetna Government |
$1,544.03
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,527.90
|
| Rate for Payer: Group Health Inc Commercial |
$1,841.74
|
| Rate for Payer: Group Health Inc Medicare |
$1,289.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,841.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,841.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,697.67
|
|
|
CHOLECYSTOSTOMY
|
Facility
OP
|
$9,417.43
|
|
|
Service Code
|
HCPCS 47490
|
| Hospital Charge Code |
40011160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$356.08 |
| Max. Negotiated Rate |
$4,708.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,000.83
|
| Rate for Payer: Aetna Government |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Cash Price |
$4,000.83
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,000.83
|
| 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 |
$4,000.83
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$356.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,400.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,560.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,000.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,560.74
|
| Rate for Payer: Group Health Inc Commercial |
$4,000.83
|
| Rate for Payer: Group Health Inc Medicare |
$4,000.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,000.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$395.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,400.71
|
| Rate for Payer: Healthfirst QHP |
$4,000.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,000.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,000.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,200.66
|
| Rate for Payer: Wellcare Medicare |
$3,800.79
|
|
|
CHOLESTEROL,TOTAL
|
Facility
OP
|
$10.88
|
|
|
Service Code
|
HCPCS 82465
|
| Hospital Charge Code |
40602480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.35
|
| Rate for Payer: Aetna Government |
$4.35
|
| Rate for Payer: Cash Price |
$4.35
|
| Rate for Payer: Cash Price |
$4.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.35
|
| Rate for Payer: EmblemHealth Commercial |
$4.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.87
|
| Rate for Payer: Group Health Inc Commercial |
$4.35
|
| Rate for Payer: Group Health Inc Medicare |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.35
|
| Rate for Payer: Healthfirst QHP |
$4.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.48
|
| Rate for Payer: Wellcare Medicare |
$3.92
|
|
|
CHOLESTYRAMINE SACHET POWDER 4 GRAMS
|
Facility
OP
|
$1.26
|
|
| Hospital Charge Code |
41643786
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.86
|
| Rate for Payer: Group Health Inc Commercial |
$0.63
|
| Rate for Payer: Group Health Inc Medicare |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.82
|
|
|
CHOLESTYRAMINE SACHET POWDER 4 GRAMS
|
Facility
OP
|
$1.26
|
|
| Hospital Charge Code |
41653786
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.86
|
| Rate for Payer: Group Health Inc Commercial |
$0.63
|
| Rate for Payer: Group Health Inc Medicare |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.82
|
|
|
CHROMIC CHLORIDE
|
Facility
OP
|
$44.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$28.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.06
|
| Rate for Payer: Aetna Government |
$22.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.36
|
| Rate for Payer: Group Health Inc Commercial |
$22.06
|
| Rate for Payer: Group Health Inc Medicare |
$15.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.67
|
|
|
CHROMIC CHLORIDE
|
Facility
IP
|
$44.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$22.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.06
|
|
|
CHROMIC CHLORIDE
|
Facility
OP
|
$44.11
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650206
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$28.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.06
|
| Rate for Payer: Aetna Government |
$22.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.36
|
| Rate for Payer: Group Health Inc Commercial |
$22.06
|
| Rate for Payer: Group Health Inc Medicare |
$15.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.67
|
|
