|
CITALOPRAM HYDROBROMIDE 10 MG PO TABS [30264]
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
NDC 00904608461
|
| Hospital Charge Code |
00904608461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.21
|
| Rate for Payer: Aetna Government |
$1.21
|
| Rate for Payer: Brighton Health Commercial |
$1.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.65
|
| Rate for Payer: Group Health Inc Commercial |
$1.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.58
|
|
|
CITALOPRAM HYDROBROMIDE 10 MG PO TABS [30264]
|
Facility
|
OP
|
$2.58
|
|
|
Service Code
|
NDC 13668000901
|
| Hospital Charge Code |
13668000901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.29
|
| Rate for Payer: Aetna Government |
$1.29
|
| Rate for Payer: Brighton Health Commercial |
$1.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.75
|
| Rate for Payer: Group Health Inc Commercial |
$1.29
|
| Rate for Payer: Group Health Inc Medicare |
$0.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.68
|
|
|
CITALOPRAM HYDROBROMIDE 10 MG PO TABS [30264]
|
Facility
|
OP
|
$2.45
|
|
|
Service Code
|
NDC 00378623101
|
| Hospital Charge Code |
00378623101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.22
|
| Rate for Payer: Aetna Government |
$1.22
|
| Rate for Payer: Brighton Health Commercial |
$1.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.66
|
| Rate for Payer: Group Health Inc Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.59
|
|
|
CITALOPRAM HYDROBROMIDE 20 MG PO TABS [21062]
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
00904608561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.35
|
| Rate for Payer: Aetna Government |
$1.35
|
| Rate for Payer: Brighton Health Commercial |
$2.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.83
|
| Rate for Payer: Group Health Inc Commercial |
$1.35
|
| Rate for Payer: Group Health Inc Medicare |
$0.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.75
|
|
|
CITALOPRAM HYDROBROMIDE 20 MG PO TABS [21062]
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
NDC 13668001001
|
| Hospital Charge Code |
13668001001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.35
|
| Rate for Payer: Aetna Government |
$1.35
|
| Rate for Payer: Brighton Health Commercial |
$2.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.83
|
| Rate for Payer: Group Health Inc Commercial |
$1.35
|
| Rate for Payer: Group Health Inc Medicare |
$0.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.75
|
|
|
CITALOPRAM HYDROBROMIDE 20 MG PO TABS [21062]
|
Facility
|
OP
|
$2.56
|
|
|
Service Code
|
NDC 00378623201
|
| Hospital Charge Code |
00378623201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.28
|
| Rate for Payer: Aetna Government |
$1.28
|
| Rate for Payer: Brighton Health Commercial |
$1.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.74
|
| Rate for Payer: Group Health Inc Commercial |
$1.28
|
| Rate for Payer: Group Health Inc Medicare |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.66
|
|
|
CITALOPRAM HYDROBROMIDE 40 MG PO TABS [23490]
|
Facility
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 00378623301
|
| Hospital Charge Code |
00378623301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.33
|
| Rate for Payer: Aetna Government |
$1.33
|
| Rate for Payer: Brighton Health Commercial |
$1.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.81
|
| Rate for Payer: Group Health Inc Commercial |
$1.33
|
| Rate for Payer: Group Health Inc Medicare |
$0.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.73
|
|
|
CITALOPRAM HYDROBROMIDE 40 MG PO TABS [23490]
|
Facility
|
OP
|
$2.78
|
|
|
Service Code
|
NDC 13668001101
|
| Hospital Charge Code |
13668001101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.39
|
| Rate for Payer: Aetna Government |
$1.39
|
| Rate for Payer: Brighton Health Commercial |
$2.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.89
|
| Rate for Payer: Group Health Inc Commercial |
$1.39
|
| Rate for Payer: Group Health Inc Medicare |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.81
|
|
|
CITRIC ACID (CITRATE), URINE
|
Facility
|
OP
|
$69.50
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
40609053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.46 |
| Max. Negotiated Rate |
$52.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.80
|
| Rate for Payer: Aetna Government |
$27.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$19.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$19.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19.46
|
| Rate for Payer: Brighton Health Commercial |
$52.12
|
| Rate for Payer: Cash Price |
$27.80
|
| Rate for Payer: Cash Price |
$27.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.80
|
| Rate for Payer: EmblemHealth Commercial |
$27.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$23.63
|
| Rate for Payer: Fidelis Essential Plan QHP |
$24.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24.74
|
| Rate for Payer: Group Health Inc Commercial |
$27.80
|
| Rate for Payer: Group Health Inc Medicare |
$27.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27.80
|
| Rate for Payer: Healthfirst QHP |
$27.80
|
| Rate for Payer: Humana Medicare |
$28.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.80
|
| Rate for Payer: United Healthcare Commercial |
$35.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.24
|
| Rate for Payer: Wellcare Medicare |
$25.02
|
|
|
CITRIC ACID (CITRATE), URINE
|
Facility
|
IP
|
$69.50
|
|
|
Service Code
|
HCPCS 82507
|
| Hospital Charge Code |
40609053
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$27.80
|
|
|
CK-ISOENZYME ELECTROPHORESIS
|
Facility
|
IP
|
$33.48
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
40607420
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$13.39
|
|
|
CK-ISOENZYME ELECTROPHORESIS
|
Facility
|
OP
|
$33.48
|
|
|
Service Code
|
HCPCS 82552
|
| Hospital Charge Code |
40607420
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.39
|
| Rate for Payer: Aetna Government |
$13.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.37
|
| Rate for Payer: Brighton Health Commercial |
$25.11
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.39
|
| Rate for Payer: EmblemHealth Commercial |
$13.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.92
|
| Rate for Payer: Group Health Inc Commercial |
$13.39
|
| Rate for Payer: Group Health Inc Medicare |
$13.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.39
|
| Rate for Payer: Healthfirst QHP |
$13.39
|
| Rate for Payer: Humana Medicare |
$13.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$16.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.71
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
|
|
CKMB.
|
Facility
|
OP
|
$28.88
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
40602646
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$21.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.55
|
| Rate for Payer: Aetna Government |
$11.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.08
|
| Rate for Payer: Brighton Health Commercial |
$21.66
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Cash Price |
$11.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.55
|
| Rate for Payer: EmblemHealth Commercial |
$11.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.28
|
| Rate for Payer: Group Health Inc Commercial |
$11.55
|
| Rate for Payer: Group Health Inc Medicare |
$11.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.55
|
| Rate for Payer: Healthfirst QHP |
$11.55
|
| Rate for Payer: Humana Medicare |
$11.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.55
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.24
|
| Rate for Payer: Wellcare Medicare |
$10.40
|
|
|
CKMB.
|
Facility
|
IP
|
$28.88
|
|
|
Service Code
|
HCPCS 82553
|
| Hospital Charge Code |
40602646
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$11.55
|
|
|
CK, TOTAL+ISOENZYMES,SERUM
|
Facility
|
OP
|
$16.28
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
40609058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.51
|
| Rate for Payer: Aetna Government |
$6.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.56
|
| Rate for Payer: Brighton Health Commercial |
$12.21
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.51
|
| Rate for Payer: EmblemHealth Commercial |
$6.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.79
|
| Rate for Payer: Group Health Inc Commercial |
$6.51
|
| Rate for Payer: Group Health Inc Medicare |
$6.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.51
|
| Rate for Payer: Healthfirst QHP |
$6.51
|
| Rate for Payer: Humana Medicare |
$6.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.51
|
| Rate for Payer: United Healthcare Commercial |
$8.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.21
|
| Rate for Payer: Wellcare Medicare |
$5.86
|
|
|
CK, TOTAL+ISOENZYMES,SERUM
|
Facility
|
IP
|
$16.28
|
|
|
Service Code
|
HCPCS 82550
|
| Hospital Charge Code |
40609058
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$6.51
|
|
|
CLADRIBINE 10MG/10ML INJECTION
|
Facility
|
OP
|
$38.58
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
41657831
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$25.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.77
|
| Rate for Payer: Aetna Government |
$15.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.04
|
| Rate for Payer: Brighton Health Commercial |
$23.15
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.56
|
| Rate for Payer: Group Health Inc Commercial |
$15.77
|
| Rate for Payer: Group Health Inc Medicare |
$15.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.41
|
| Rate for Payer: Healthfirst QHP |
$15.77
|
| Rate for Payer: Humana Medicare |
$16.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.59
|
| Rate for Payer: SOMOS Essential |
$17.59
|
| Rate for Payer: United Healthcare Commercial |
$23.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.62
|
| Rate for Payer: Wellcare Medicare |
$14.98
|
|
|
CLADRIBINE 10MG/10ML INJECTION
|
Facility
|
IP
|
$38.58
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
41647831
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$19.29 |
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.29
|
|
|
CLADRIBINE 10MG/10ML INJECTION
|
Facility
|
IP
|
$38.58
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
41657831
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.29 |
| Max. Negotiated Rate |
$19.29 |
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.29
|
|
|
CLADRIBINE 10MG/10ML INJECTION
|
Facility
|
OP
|
$38.58
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
41647831
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$25.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.77
|
| Rate for Payer: Aetna Government |
$15.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.04
|
| Rate for Payer: Brighton Health Commercial |
$23.15
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.77
|
| Rate for Payer: EmblemHealth Commercial |
$15.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.56
|
| Rate for Payer: Group Health Inc Commercial |
$15.77
|
| Rate for Payer: Group Health Inc Medicare |
$15.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.41
|
| Rate for Payer: Healthfirst QHP |
$15.77
|
| Rate for Payer: Humana Medicare |
$16.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.77
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.59
|
| Rate for Payer: SOMOS Essential |
$17.59
|
| Rate for Payer: United Healthcare Commercial |
$23.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.62
|
| Rate for Payer: Wellcare Medicare |
$14.98
|
|
|
CLAMP
|
Facility
|
OP
|
$994.50
|
|
| Hospital Charge Code |
64904057
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$348.08 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$546.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$497.25
|
| Rate for Payer: Aetna Government |
$497.25
|
| Rate for Payer: Brighton Health Commercial |
$745.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$795.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$676.26
|
| Rate for Payer: Group Health Inc Commercial |
$497.25
|
| Rate for Payer: Group Health Inc Medicare |
$348.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$497.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$497.25
|
|
|
CLAMP
|
Facility
|
OP
|
$538.00
|
|
| Hospital Charge Code |
40202168
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$188.30 |
| Max. Negotiated Rate |
$430.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$295.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$269.00
|
| Rate for Payer: Aetna Government |
$269.00
|
| Rate for Payer: Brighton Health Commercial |
$403.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$430.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$365.84
|
| Rate for Payer: Group Health Inc Commercial |
$269.00
|
| Rate for Payer: Group Health Inc Medicare |
$188.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$269.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$269.00
|
|
|
CLAMP 10 HOLE
|
Facility
|
OP
|
$1,460.00
|
|
| Hospital Charge Code |
64905945
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$511.00 |
| Max. Negotiated Rate |
$1,168.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$803.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$730.00
|
| Rate for Payer: Aetna Government |
$730.00
|
| Rate for Payer: Brighton Health Commercial |
$1,095.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,168.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$992.80
|
| Rate for Payer: Group Health Inc Commercial |
$730.00
|
| Rate for Payer: Group Health Inc Medicare |
$511.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$730.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$730.00
|
|
|
CLAMP 4.0MM ADJUSTABLE MR SAFE
|
Facility
|
OP
|
$1,442.00
|
|
| Hospital Charge Code |
40200190
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$504.70 |
| Max. Negotiated Rate |
$1,153.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$793.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$721.00
|
| Rate for Payer: Aetna Government |
$721.00
|
| Rate for Payer: Brighton Health Commercial |
$1,081.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,153.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$980.56
|
| Rate for Payer: Group Health Inc Commercial |
$721.00
|
| Rate for Payer: Group Health Inc Medicare |
$504.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$721.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$721.00
|
|
|
CLAMP 5 HOLE
|
Facility
|
OP
|
$848.40
|
|
| Hospital Charge Code |
40202169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$296.94 |
| Max. Negotiated Rate |
$678.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$466.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$424.20
|
| Rate for Payer: Aetna Government |
$424.20
|
| Rate for Payer: Brighton Health Commercial |
$636.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$678.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$576.91
|
| Rate for Payer: Group Health Inc Commercial |
$424.20
|
| Rate for Payer: Group Health Inc Medicare |
$296.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$424.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$424.20
|
|
