|
ADMINSTRATION OF EVUSHELD
|
Facility
OP
|
$102.55
|
|
|
Service Code
|
HCPCS M0220
|
| Hospital Charge Code |
30300260
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$51.28 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$182.66
|
| Rate for Payer: Aetna Government |
$182.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$182.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$82.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$182.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$155.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$162.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$182.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$162.57
|
| 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 |
$51.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$182.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$155.26
|
| Rate for Payer: Healthfirst QHP |
$182.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$182.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$182.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$146.13
|
| Rate for Payer: Wellcare Medicare |
$173.53
|
|
|
ADMINSTRATION OF VACCINE
|
Facility
OP
|
$183.15
|
|
|
Service Code
|
HCPCS 90471
|
| Hospital Charge Code |
30305049
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$250.00 |
| 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: 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: Fidelis CHP/HARP/Medicaid |
$21.71
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$24.12
|
| 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
|
|
|
ADMISSIONS KITS
|
Facility
OP
|
$12.05
|
|
| Hospital Charge Code |
40200333
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
ADM SARSCOV2 30MCG/0.3ML 3RD DOSE
|
Facility
OP
|
$120.55
|
|
|
Service Code
|
HCPCS 0003A
|
| Hospital Charge Code |
30302529
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.00
|
| Rate for Payer: Aetna Government |
$40.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.97
|
| 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 |
$60.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.28
|
|
|
ADM SARSCOV2 VAC AD26 .5ML
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
HCPCS 0031A
|
| Hospital Charge Code |
30300266
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.00
|
| Rate for Payer: Aetna Government |
$40.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.60
|
| 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 |
$22.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.50
|
|
|
ADM. SET,FOR BLOOD, Y-TYPE
|
Facility
OP
|
$14.53
|
|
| Hospital Charge Code |
40200330
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.26
|
| Rate for Payer: Aetna Government |
$7.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.88
|
| Rate for Payer: Group Health Inc Commercial |
$7.26
|
| Rate for Payer: Group Health Inc Medicare |
$5.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.26
|
|
|
ADM.SET,INTRAVENUS-SHT.NEEDLE
|
Facility
OP
|
$14.53
|
|
| Hospital Charge Code |
40200320
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.26
|
| Rate for Payer: Aetna Government |
$7.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.88
|
| Rate for Payer: Group Health Inc Commercial |
$7.26
|
| Rate for Payer: Group Health Inc Medicare |
$5.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.26
|
|
|
A&D Ointment
|
Facility
OP
|
$2.84
|
|
| Hospital Charge Code |
40200300
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.42
|
| Rate for Payer: Aetna Government |
$1.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.93
|
| Rate for Payer: Group Health Inc Commercial |
$1.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.42
|
|
|
ADO-TRASTUZUMAB 100MG/5ML -10MG
|
Facility
IP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41658445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$26.63 |
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
|
|
ADO-TRASTUZUMAB 100MG/5ML -10MG
|
Facility
OP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41648445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.37
|
| Rate for Payer: Aetna Government |
$38.37
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.37
|
| Rate for Payer: EmblemHealth Commercial |
$38.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.29
|
| Rate for Payer: Group Health Inc Commercial |
$38.37
|
| Rate for Payer: Group Health Inc Medicare |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.61
|
| Rate for Payer: Healthfirst QHP |
$38.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.74
|
| Rate for Payer: SOMOS Essential |
$40.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.69
|
| Rate for Payer: Wellcare Medicare |
$36.45
|
|
|
ADO-TRASTUZUMAB 100MG/5ML -10MG
|
Facility
OP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41658445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.37
|
| Rate for Payer: Aetna Government |
$38.37
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.37
|
| Rate for Payer: EmblemHealth Commercial |
$38.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.29
|
| Rate for Payer: Group Health Inc Commercial |
$38.37
|
| Rate for Payer: Group Health Inc Medicare |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.61
|
| Rate for Payer: Healthfirst QHP |
$38.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.74
|
| Rate for Payer: SOMOS Essential |
$40.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.69
|
| Rate for Payer: Wellcare Medicare |
$36.45
|
|
|
ADO-TRASTUZUMAB 100MG/5ML -10MG
|
Facility
IP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41648445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$26.63 |
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
|
|
ADO-TRASTUZUMAB 160MG/8ML - 10MG
|
Facility
OP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41658446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.37
|
| Rate for Payer: Aetna Government |
$38.37
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.37
|
| Rate for Payer: EmblemHealth Commercial |
$38.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.29
|
| Rate for Payer: Group Health Inc Commercial |
$38.37
|
| Rate for Payer: Group Health Inc Medicare |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.61
|
| Rate for Payer: Healthfirst QHP |
$38.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.74
|
| Rate for Payer: SOMOS Essential |
$40.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.69
|
| Rate for Payer: Wellcare Medicare |
$36.45
|
|
|
ADO-TRASTUZUMAB 160MG/8ML - 10MG
|
Facility
IP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41648446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$26.63 |
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
|
|
ADO-TRASTUZUMAB 160MG/8ML - 10MG
|
Facility
OP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41648446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$40.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.37
|
| Rate for Payer: Aetna Government |
$38.37
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.37
|
| Rate for Payer: EmblemHealth Commercial |
$38.37
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$38.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.29
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.29
|
| Rate for Payer: Group Health Inc Commercial |
$38.37
|
| Rate for Payer: Group Health Inc Medicare |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.61
|
| Rate for Payer: Healthfirst QHP |
$38.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40.74
|
| Rate for Payer: SOMOS Essential |
$40.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.69
|
| Rate for Payer: Wellcare Medicare |
$36.45
|
|
|
ADO-TRASTUZUMAB 160MG/8ML - 10MG
|
Facility
IP
|
$53.26
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
41658446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$26.63 |
| Rate for Payer: Cash Price |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.63
|
|
|
ADPT OSTMY BLT LG 34-65 86-165CM
|
Facility
OP
|
$32.20
|
|
|
Service Code
|
HCPCS A4387
|
| Hospital Charge Code |
40005167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.36
|
| Rate for Payer: Aetna Government |
$1.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.90
|
| Rate for Payer: Group Health Inc Commercial |
$16.10
|
| Rate for Payer: Group Health Inc Medicare |
$11.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.10
|
|
|
ADPT OSTMY BLT MD 23-43 58-109CM
|
Facility
OP
|
$32.20
|
|
|
Service Code
|
HCPCS A4387
|
| Hospital Charge Code |
40005168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.36
|
| Rate for Payer: Aetna Government |
$1.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.90
|
| Rate for Payer: Group Health Inc Commercial |
$16.10
|
| Rate for Payer: Group Health Inc Medicare |
$11.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.10
|
|
|
ADPT OVL CVX RNG1-3/16X1-7/8
|
Facility
OP
|
$43.90
|
|
|
Service Code
|
HCPCS A4411
|
| Hospital Charge Code |
40005181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.10
|
| Rate for Payer: Aetna Government |
$3.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.85
|
| Rate for Payer: Group Health Inc Commercial |
$21.95
|
| Rate for Payer: Group Health Inc Medicare |
$15.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.95
|
|
|
ADPT OVL RNG7/8X1-1/2 22X38MM
|
Facility
OP
|
$43.90
|
|
|
Service Code
|
HCPCS A4411
|
| Hospital Charge Code |
40005180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.10
|
| Rate for Payer: Aetna Government |
$3.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.85
|
| Rate for Payer: Group Health Inc Commercial |
$21.95
|
| Rate for Payer: Group Health Inc Medicare |
$15.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.95
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
IP
|
$39,333.99
|
|
|
Service Code
|
MS-DRG 614
|
| Min. Negotiated Rate |
$17,931.67 |
| Max. Negotiated Rate |
$39,333.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33,211.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,562.74
|
| Rate for Payer: Aetna Government |
$38,562.74
|
| Rate for Payer: Brighton Health Commercial |
$32,659.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,333.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38,896.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32,099.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,634.60
|
| Rate for Payer: EmblemHealth Commercial |
$19,314.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,562.74
|
| Rate for Payer: Group Health Inc Commercial |
$38,562.74
|
| Rate for Payer: Group Health Inc Medicare |
$38,562.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,562.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,931.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,562.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,562.74
|
| Rate for Payer: Wellcare Medicare |
$36,634.60
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$28,282.70
|
|
|
Service Code
|
MS-DRG 615
|
| Min. Negotiated Rate |
$12,614.70 |
| Max. Negotiated Rate |
$28,282.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,691.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,728.14
|
| Rate for Payer: Aetna Government |
$27,728.14
|
| Rate for Payer: Brighton Health Commercial |
$21,330.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,282.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,404.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,964.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,341.73
|
| Rate for Payer: EmblemHealth Commercial |
$12,614.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,728.14
|
| Rate for Payer: Group Health Inc Commercial |
$27,728.14
|
| Rate for Payer: Group Health Inc Medicare |
$27,728.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,728.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,893.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,728.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,728.14
|
| Rate for Payer: Wellcare Medicare |
$26,341.73
|
|
|
ADULT LANYNYOSCOPY TRAY
|
Facility
OP
|
$7,500.00
|
|
| Hospital Charge Code |
64905987
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,625.00 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,125.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,750.00
|
| Rate for Payer: Aetna Government |
$3,750.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,100.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,750.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,750.00
|
|
|
ADVANCE CARE PLAN IN RCRD
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
HCPCS 1157F
|
| Hospital Charge Code |
30305808
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| 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 |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
ADVANCE MALE SLING SYSTEM
|
Facility
IP
|
$12,462.56
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
40204570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,231.28 |
| Max. Negotiated Rate |
$6,231.28 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,231.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,231.28
|
|
