|
CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN [9626]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
00338361224
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.90
|
| Rate for Payer: Aetna Government |
$1.90
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.90
|
| Rate for Payer: EmblemHealth Commercial |
$0.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$1.90
|
| Rate for Payer: Group Health Inc Medicare |
$1.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.62
|
| Rate for Payer: Healthfirst QHP |
$1.90
|
| Rate for Payer: Humana Medicare |
$1.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.52
|
|
|
CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN [9626]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
00338361250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
|
|
CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN [9626]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
00338361650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.90
|
| Rate for Payer: Aetna Government |
$1.90
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.90
|
| Rate for Payer: EmblemHealth Commercial |
$0.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$1.90
|
| Rate for Payer: Group Health Inc Medicare |
$1.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.62
|
| Rate for Payer: Healthfirst QHP |
$1.90
|
| Rate for Payer: Humana Medicare |
$1.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.52
|
|
|
CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN [9626]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
00781328991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.90
|
| Rate for Payer: Aetna Government |
$1.90
|
| Rate for Payer: Brighton Health Commercial |
$0.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.90
|
| Rate for Payer: EmblemHealth Commercial |
$0.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$1.90
|
| Rate for Payer: Group Health Inc Medicare |
$1.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.62
|
| Rate for Payer: Healthfirst QHP |
$1.90
|
| Rate for Payer: Humana Medicare |
$1.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.52
|
|
|
CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN [9626]
|
Facility
|
IP
|
$0.26
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
00338361650
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
|
|
CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN [9626]
|
Facility
|
OP
|
$0.26
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
00338361250
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.90
|
| Rate for Payer: Aetna Government |
$1.90
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.90
|
| Rate for Payer: EmblemHealth Commercial |
$0.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$1.90
|
| Rate for Payer: Group Health Inc Medicare |
$1.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.62
|
| Rate for Payer: Healthfirst QHP |
$1.90
|
| Rate for Payer: Humana Medicare |
$1.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.52
|
|
|
CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN [9627]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
00338381450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.90
|
| Rate for Payer: Aetna Government |
$1.90
|
| Rate for Payer: Brighton Health Commercial |
$0.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.90
|
| Rate for Payer: EmblemHealth Commercial |
$0.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$1.90
|
| Rate for Payer: Group Health Inc Medicare |
$1.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1.62
|
| Rate for Payer: Healthfirst QHP |
$1.90
|
| Rate for Payer: Humana Medicare |
$1.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1.52
|
|
|
CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN [9627]
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
00338381450
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
|
|
CLINDAMYCIN TOPICAL 1% SOLN 30 ML
|
Facility
|
OP
|
$8.04
|
|
| Hospital Charge Code |
41643562
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$6.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.02
|
| Rate for Payer: Aetna Government |
$4.02
|
| Rate for Payer: Brighton Health Commercial |
$6.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.47
|
| Rate for Payer: Group Health Inc Commercial |
$4.02
|
| Rate for Payer: Group Health Inc Medicare |
$2.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.23
|
|
|
CLINDAMYCIN TOPICAL 1% SOLN 30 ML
|
Facility
|
OP
|
$8.04
|
|
| Hospital Charge Code |
41653562
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$6.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.02
|
| Rate for Payer: Aetna Government |
$4.02
|
| Rate for Payer: Brighton Health Commercial |
$6.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.47
|
| Rate for Payer: Group Health Inc Commercial |
$4.02
|
| Rate for Payer: Group Health Inc Medicare |
$2.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.23
|
|
|
CLINICAL TREAT PLAN COMP
|
Facility
|
OP
|
$661.19
|
|
|
Service Code
|
HCPCS 77263
|
| Hospital Charge Code |
66542926
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$207.09 |
| Max. Negotiated Rate |
$528.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$363.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$207.09
|
| Rate for Payer: Aetna Government |
$207.09
|
| Rate for Payer: Brighton Health Commercial |
$495.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$528.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$449.61
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$330.60
|
| Rate for Payer: Group Health Inc Medicare |
$231.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$330.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$330.60
|
|
|
CLINICAL TREAT PLAN INTER
|
Facility
|
OP
|
$448.32
|
|
|
Service Code
|
HCPCS 77262
|
| Hospital Charge Code |
66542925
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$358.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$246.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$141.60
|
| Rate for Payer: Aetna Government |
$141.60
|
| Rate for Payer: Brighton Health Commercial |
$336.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$358.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$304.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$224.16
|
| Rate for Payer: Group Health Inc Medicare |
$156.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$224.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$224.16
|
|
|
CLINICAL TREAT PLAN SIMPLE
|
Facility
|
OP
|
$298.20
|
|
|
Service Code
|
HCPCS 77261
|
| Hospital Charge Code |
66542924
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.55 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$164.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$94.55
|
| Rate for Payer: Aetna Government |
$94.55
|
| Rate for Payer: Brighton Health Commercial |
$223.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$238.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$202.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$149.10
|
| Rate for Payer: Group Health Inc Medicare |
$104.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$149.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$149.10
|
|
|
CLINIC ESTABLISH PATIENT
|
Facility
|
OP
|
$979.88
|
|
|
Service Code
|
HCPCS 99211
|
| Hospital Charge Code |
30300003
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$538.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.70
|
| Rate for Payer: Aetna Government |
$6.70
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.20
|
| Rate for Payer: Amida Care Medicaid |
$20.20
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,020.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.21
|
| 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 |
$20.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$489.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.20
|
| Rate for Payer: Healthfirst Essential Plan |
$45.45
|
| Rate for Payer: Healthfirst QHP |
$20.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20.20
|
| Rate for Payer: SOMOS Essential |
$20.20
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45.45
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$22.22
|
| Rate for Payer: United Healthcare Medicaid |
$20.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20.20
|
|
|
CLINIC STRAIGHT FWD MED DECISION
|
Facility
|
OP
|
$1,246.36
|
|
|
Service Code
|
HCPCS 99212
|
| Hospital Charge Code |
30300004
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$685.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$685.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.50
|
| Rate for Payer: Aetna Government |
$18.50
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| 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 |
$623.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$623.18
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
CLINIMIX 2.75-5% 1L
|
Facility
|
OP
|
$12.73
|
|
| Hospital Charge Code |
41658459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.36
|
| Rate for Payer: Aetna Government |
$6.36
|
| Rate for Payer: Brighton Health Commercial |
$9.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.66
|
| Rate for Payer: Group Health Inc Commercial |
$6.36
|
| Rate for Payer: Group Health Inc Medicare |
$4.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.27
|
|
|
CLINIMIX 2.75-5% 1L
|
Facility
|
OP
|
$12.73
|
|
| Hospital Charge Code |
41648459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$10.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.36
|
| Rate for Payer: Aetna Government |
$6.36
|
| Rate for Payer: Brighton Health Commercial |
$9.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.66
|
| Rate for Payer: Group Health Inc Commercial |
$6.36
|
| Rate for Payer: Group Health Inc Medicare |
$4.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.27
|
|
|
CLINIMIX 2.75-5% 2L
|
Facility
|
OP
|
$50.34
|
|
| Hospital Charge Code |
41648562
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.17
|
| Rate for Payer: Aetna Government |
$25.17
|
| Rate for Payer: Brighton Health Commercial |
$37.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.23
|
| Rate for Payer: Group Health Inc Commercial |
$25.17
|
| Rate for Payer: Group Health Inc Medicare |
$17.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.72
|
|
|
CLINIMIX 2.75-5% 2L
|
Facility
|
OP
|
$50.34
|
|
| Hospital Charge Code |
41658562
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$40.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.17
|
| Rate for Payer: Aetna Government |
$25.17
|
| Rate for Payer: Brighton Health Commercial |
$37.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.23
|
| Rate for Payer: Group Health Inc Commercial |
$25.17
|
| Rate for Payer: Group Health Inc Medicare |
$17.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.72
|
|
|
CLINIMIX 4.25-10% 1L
|
Facility
|
OP
|
$19.83
|
|
| Hospital Charge Code |
41658565
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$15.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.92
|
| Rate for Payer: Aetna Government |
$9.92
|
| Rate for Payer: Brighton Health Commercial |
$14.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.48
|
| Rate for Payer: Group Health Inc Commercial |
$9.92
|
| Rate for Payer: Group Health Inc Medicare |
$6.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.89
|
|
|
CLINIMIX 4.25-10% 1L
|
Facility
|
OP
|
$19.83
|
|
| Hospital Charge Code |
41648565
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$15.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.92
|
| Rate for Payer: Aetna Government |
$9.92
|
| Rate for Payer: Brighton Health Commercial |
$14.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.48
|
| Rate for Payer: Group Health Inc Commercial |
$9.92
|
| Rate for Payer: Group Health Inc Medicare |
$6.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.89
|
|
|
CLINIMIX 4.25-10% 2L
|
Facility
|
OP
|
$23.86
|
|
| Hospital Charge Code |
41658560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.93
|
| Rate for Payer: Aetna Government |
$11.93
|
| Rate for Payer: Brighton Health Commercial |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.22
|
| Rate for Payer: Group Health Inc Commercial |
$11.93
|
| Rate for Payer: Group Health Inc Medicare |
$8.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.51
|
|
|
CLINIMIX 4.25-10% 2L
|
Facility
|
OP
|
$23.86
|
|
| Hospital Charge Code |
41648560
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.93
|
| Rate for Payer: Aetna Government |
$11.93
|
| Rate for Payer: Brighton Health Commercial |
$17.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.22
|
| Rate for Payer: Group Health Inc Commercial |
$11.93
|
| Rate for Payer: Group Health Inc Medicare |
$8.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.51
|
|
|
CLINIMIX 4.25/5
|
Facility
|
OP
|
$0.01
|
|
| Hospital Charge Code |
41650360
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
CLINIMIX 4.25/5
|
Facility
|
OP
|
$0.01
|
|
| Hospital Charge Code |
41640360
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
