|
DEXTROSE 25% INJ SYR
|
Facility
OP
|
$9.46
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
41652710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.73
|
| Rate for Payer: Aetna Government |
$4.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.73
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.73
|
| Rate for Payer: Group Health Inc Medicare |
$3.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.15
|
|
|
DEXTROSE 2.5% WATER INFUSION 1000 ML
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41644017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
DEXTROSE 2.5% WATER INFUSION 1000 ML
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41654017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
DEXTROSE 5% + 0.225% NACL + 10 MEQ KCL I
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41654249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
DEXTROSE 5% + 0.225% NACL + 10 MEQ KCL I
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41644249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
DEXTROSE 5% + 0.225% NACL INFUSION 1000
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
41651458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DEXTROSE 5% + 0.225% NACL INFUSION 1000
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
41641458
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DEXTROSE 5% + 0.33% NACL + 10 MEQ KCL IN
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41652103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DEXTROSE 5% + 0.33% NACL + 10 MEQ KCL IN
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41642103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DEXTROSE 5% + 0.33% NACL + 20 MEQ KCL IN
|
Facility
OP
|
$3.16
|
|
| Hospital Charge Code |
41652054
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.58
|
| Rate for Payer: Aetna Government |
$1.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.15
|
| Rate for Payer: Group Health Inc Commercial |
$1.58
|
| Rate for Payer: Group Health Inc Medicare |
$1.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.05
|
|
|
DEXTROSE 5% + 0.33% NACL + 20 MEQ KCL IN
|
Facility
OP
|
$3.16
|
|
| Hospital Charge Code |
41642054
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.58
|
| Rate for Payer: Aetna Government |
$1.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.53
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.15
|
| Rate for Payer: Group Health Inc Commercial |
$1.58
|
| Rate for Payer: Group Health Inc Medicare |
$1.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.05
|
|
|
DEXTROSE 5% + 0.33% NACL INFUSION 1000 M
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
41651459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DEXTROSE 5% + 0.33% NACL INFUSION 1000 M
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
41641459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DEXTROSE 5% + 0.45% NACL + 10 MEQ KCL IN
|
Facility
OP
|
$3.31
|
|
| Hospital Charge Code |
41651970
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.66
|
| Rate for Payer: Aetna Government |
$1.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.25
|
| Rate for Payer: Group Health Inc Commercial |
$1.66
|
| Rate for Payer: Group Health Inc Medicare |
$1.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.15
|
|
|
DEXTROSE 5% + 0.45% NACL + 10 MEQ KCL IN
|
Facility
OP
|
$3.31
|
|
| Hospital Charge Code |
41641970
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.66
|
| Rate for Payer: Aetna Government |
$1.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.25
|
| Rate for Payer: Group Health Inc Commercial |
$1.66
|
| Rate for Payer: Group Health Inc Medicare |
$1.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.15
|
|
|
DEXTROSE 5% + 0.45% NACL + 20 MEQ KCL IN
|
Facility
OP
|
$0.38
|
|
| Hospital Charge Code |
41641971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
DEXTROSE 5% + 0.45% NACL + 20 MEQ KCL IN
|
Facility
OP
|
$0.38
|
|
| Hospital Charge Code |
41651971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
DEXTROSE 5% + 0.45% NACL + 40 MEQ KCL IN
|
Facility
OP
|
$2.62
|
|
| Hospital Charge Code |
41652278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.31
|
| Rate for Payer: Aetna Government |
$1.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.78
|
| Rate for Payer: Group Health Inc Commercial |
$1.31
|
| Rate for Payer: Group Health Inc Medicare |
$0.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.70
|
|
|
DEXTROSE 5% + 0.45% NACL + 40 MEQ KCL IN
|
Facility
OP
|
$2.62
|
|
| Hospital Charge Code |
41642278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.31
|
| Rate for Payer: Aetna Government |
$1.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.78
|
| Rate for Payer: Group Health Inc Commercial |
$1.31
|
| Rate for Payer: Group Health Inc Medicare |
$0.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.70
|
|
|
DEXTROSE 5% + 0.45% NACL INFUSION 1000 M
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
41651460
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DEXTROSE 5% + 0.45% NACL INFUSION 1000 M
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
41641460
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DEXTROSE 5%+0.9% NACL + 20MEQ KCL
|
Facility
OP
|
$5.96
|
|
| Hospital Charge Code |
41656866
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.98
|
| Rate for Payer: Aetna Government |
$2.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.05
|
| Rate for Payer: Group Health Inc Commercial |
$2.98
|
| Rate for Payer: Group Health Inc Medicare |
$2.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.87
|
|
|
DEXTROSE 5%+0.9% NACL+20MEQ KCL
|
Facility
OP
|
$5.96
|
|
| Hospital Charge Code |
41646866
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.98
|
| Rate for Payer: Aetna Government |
$2.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.05
|
| Rate for Payer: Group Health Inc Commercial |
$2.98
|
| Rate for Payer: Group Health Inc Medicare |
$2.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.87
|
|
|
DEXTROSE 5% + 0.9% NACL INFUSION 1000 ML
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7042
|
| Hospital Charge Code |
41641461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.08
|
| Rate for Payer: Aetna Government |
$1.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.06
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
DEXTROSE 5% + 0.9% NACL INFUSION 1000 ML
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J7042
|
| Hospital Charge Code |
41651461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.08
|
| Rate for Payer: Aetna Government |
$1.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.06
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.18
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$1.13
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1.20
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$1.20
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$1.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
