|
ADDERALL XR 10MG
|
Facility
OP
|
$0.02
|
|
| Hospital Charge Code |
41658427
|
|
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
|
|
|
ADDERALL XR 5MG
|
Facility
OP
|
$0.02
|
|
| Hospital Charge Code |
41648426
|
|
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
|
|
|
ADDERALL XR 5MG
|
Facility
OP
|
$0.02
|
|
| Hospital Charge Code |
41658426
|
|
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
|
|
|
ADD. FROZ SECT ON SAME SPECIM
|
Facility
OP
|
$81.51
|
|
|
Service Code
|
HCPCS 88332
|
| Hospital Charge Code |
40635440
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$10.72 |
| Max. Negotiated Rate |
$64.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.49
|
| Rate for Payer: Aetna Government |
$31.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.11
|
| Rate for Payer: Group Health Inc Commercial |
$40.76
|
| Rate for Payer: Group Health Inc Medicare |
$28.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.57
|
|
|
ADD'L SUBCUTANEOUS INF
|
Facility
OP
|
$115.43
|
|
|
Service Code
|
HCPCS 96370
|
| Hospital Charge Code |
40509899
|
|
Hospital Revenue Code
|
269
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$30,767.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Amida Care Medicaid |
$307.67
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: EmblemHealth Commercial |
$54.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30,767.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$307.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$54.93
|
| Rate for Payer: Group Health Inc Medicare |
$54.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.67
|
| Rate for Payer: Healthfirst Essential Plan |
$692.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.69
|
| Rate for Payer: Healthfirst QHP |
$307.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.67
|
| Rate for Payer: SOMOS Essential |
$692.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
ADD SEQUEN INF UP TO 1 HOUR
|
Facility
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
30106646
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.22 |
| Max. Negotiated Rate |
$146.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.50
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
ADD SEQUEN INFUSION UP TO 1 HR
|
Facility
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 96367
|
| Hospital Charge Code |
30306651
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$31.22 |
| Max. Negotiated Rate |
$146.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.46
|
| Rate for Payer: Aetna Government |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Cash Price |
$81.46
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$81.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$81.46
|
| Rate for Payer: EmblemHealth Commercial |
$81.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$69.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$72.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$81.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$72.50
|
| Rate for Payer: Group Health Inc Commercial |
$81.46
|
| Rate for Payer: Group Health Inc Medicare |
$81.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$69.24
|
| Rate for Payer: Healthfirst QHP |
$81.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$81.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$81.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.17
|
| Rate for Payer: Wellcare Medicare |
$77.39
|
|
|
ADD TOOTH TO EXISTING PARTIAL DEN
|
Facility
OP
|
$162.50
|
|
|
Service Code
|
HCPCS D5650
|
| Hospital Charge Code |
42301085
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$89.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55.05
|
| Rate for Payer: Aetna Government |
$55.05
|
| 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 |
$81.25
|
| Rate for Payer: Group Health Inc Medicare |
$56.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$81.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.25
|
|
|
ADD WALKER TO CAST
|
Facility
OP
|
$674.00
|
|
|
Service Code
|
HCPCS 29440
|
| Hospital Charge Code |
30301172
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.94 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.22
|
| Rate for Payer: Aetna Government |
$182.22
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Cash Price |
$182.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.22
|
| 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 |
$182.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$154.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.18
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$337.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$154.89
|
| Rate for Payer: Healthfirst QHP |
$182.22
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$182.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$145.78
|
| Rate for Payer: Wellcare Medicare |
$173.11
|
|
|
Adenoidectomy, primary; age 12 or over
|
Facility
OP
|
$3,723.23
|
|
|
Service Code
|
CPT 42831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$257.62 |
| Max. Negotiated Rate |
$3,723.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| 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 |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$257.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$286.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
ADENOSINE
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
41655637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna Government |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.49
|
| 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: Healthfirst CHP/FHP/Medicaid |
$0.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.59
|
| Rate for Payer: SOMOS Essential |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ADENOSINE
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
41645637
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna Government |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.49
|
| 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: Healthfirst CHP/FHP/Medicaid |
$0.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.59
|
| Rate for Payer: SOMOS Essential |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ADENOSINE
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
41655637
|
|
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
|
|
|
ADENOSINE
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
41645637
|
|
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
|
|
|
ADENOSINE DEAMINASE,PLEURAL FI
|
Facility
OP
|
$20.25
|
|
|
Service Code
|
HCPCS 84311
|
| Hospital Charge Code |
40609117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.10
|
| Rate for Payer: Aetna Government |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.10
|
| Rate for Payer: EmblemHealth Commercial |
$8.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.21
|
| Rate for Payer: Group Health Inc Commercial |
$8.10
|
| Rate for Payer: Group Health Inc Medicare |
$8.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.10
|
| Rate for Payer: Healthfirst QHP |
$8.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.48
|
| Rate for Payer: Wellcare Medicare |
$7.29
|
|
|
ADENOSINE INJ 1 MG
|
Facility
OP
|
$5.57
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
41653431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna Government |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.49
|
| Rate for Payer: Group Health Inc Commercial |
$2.78
|
| Rate for Payer: Group Health Inc Medicare |
$1.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.59
|
| Rate for Payer: SOMOS Essential |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.62
|
|
|
ADENOSINE INJ 1 MG
|
Facility
IP
|
$5.57
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
41653431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.78
|
|
|
ADENOSINE INJ, 1 MG
|
Facility
OP
|
$5.57
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
41643431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.53
|
| Rate for Payer: Aetna Government |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.49
|
| Rate for Payer: Group Health Inc Commercial |
$2.78
|
| Rate for Payer: Group Health Inc Medicare |
$1.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.54
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.59
|
| Rate for Payer: SOMOS Essential |
$0.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.62
|
|
|
ADENOSINE INJ, 1 MG
|
Facility
IP
|
$5.57
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
41643431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.78 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.78
|
|
|
ADENOVIRUS AG IF
|
Facility
OP
|
$36.08
|
|
|
Service Code
|
HCPCS 87260
|
| Hospital Charge Code |
40613065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$19.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.43
|
| Rate for Payer: Aetna Government |
$14.43
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.13
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.43
|
| Rate for Payer: EmblemHealth Commercial |
$14.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.84
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.84
|
| Rate for Payer: Group Health Inc Commercial |
$14.43
|
| Rate for Payer: Group Health Inc Medicare |
$14.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.43
|
| Rate for Payer: Healthfirst QHP |
$14.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.54
|
| Rate for Payer: Wellcare Medicare |
$12.99
|
|
|
ADENOVIRUS VACCINE TYPE 4
|
Facility
OP
|
$25.30
|
|
|
Service Code
|
HCPCS 90476
|
| Hospital Charge Code |
30101227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$48.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.00
|
| Rate for Payer: Aetna Government |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.00
|
| Rate for Payer: EmblemHealth Commercial |
$46.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$46.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$48.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$48.30
|
| Rate for Payer: Group Health Inc Commercial |
$46.00
|
| Rate for Payer: Group Health Inc Medicare |
$46.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.10
|
| Rate for Payer: Healthfirst QHP |
$46.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$36.80
|
| Rate for Payer: Wellcare Medicare |
$43.70
|
|
|
ADENOVIRUS VACCINE TYPE 4
|
Facility
IP
|
$25.30
|
|
|
Service Code
|
HCPCS 90476
|
| Hospital Charge Code |
30101227
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$12.65 |
| Rate for Payer: Cash Price |
$46.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.65
|
|
|
ADH
|
Facility
OP
|
$84.85
|
|
|
Service Code
|
HCPCS 84588
|
| Hospital Charge Code |
40609128
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.15 |
| Max. Negotiated Rate |
$53.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$46.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.94
|
| Rate for Payer: Aetna Government |
$33.94
|
| Rate for Payer: Cash Price |
$33.94
|
| Rate for Payer: Cash Price |
$33.94
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$45.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$33.94
|
| Rate for Payer: EmblemHealth Commercial |
$33.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$28.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$33.94
|
| Rate for Payer: Fidelis Qualified Health Plan |
$30.21
|
| Rate for Payer: Group Health Inc Commercial |
$33.94
|
| Rate for Payer: Group Health Inc Medicare |
$33.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$33.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$33.94
|
| Rate for Payer: Healthfirst QHP |
$33.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.15
|
| Rate for Payer: Wellcare Medicare |
$30.55
|
|
|
ADHESION SEPRA FILM
|
Facility
OP
|
$497.00
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
40209707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$173.95 |
| Max. Negotiated Rate |
$521.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$273.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$459.79
|
| Rate for Payer: Aetna Government |
$459.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$248.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$285.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$521.85
|
| Rate for Payer: Group Health Inc Commercial |
$248.50
|
| Rate for Payer: Group Health Inc Medicare |
$173.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$248.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$248.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$323.05
|
|
|
ADHESION SEPRA FILM
|
Facility
IP
|
$497.00
|
|
|
Service Code
|
HCPCS C1765
|
| Hospital Charge Code |
40209707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$248.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$248.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$248.50
|
|
