|
CMV QUANT DNA PCR (PLASMA)
|
Facility
|
OP
|
$107.10
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
40619199
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$80.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.84
|
| Rate for Payer: Aetna Government |
$42.84
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$29.99
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$29.99
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.99
|
| Rate for Payer: Brighton Health Commercial |
$80.32
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Cash Price |
$42.84
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$42.84
|
| Rate for Payer: EmblemHealth Commercial |
$42.84
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$36.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.84
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.13
|
| Rate for Payer: Group Health Inc Commercial |
$42.84
|
| Rate for Payer: Group Health Inc Medicare |
$42.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.84
|
| Rate for Payer: Healthfirst QHP |
$42.84
|
| Rate for Payer: Humana Medicare |
$43.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare Commercial |
$54.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.84
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.27
|
| Rate for Payer: Wellcare Medicare |
$38.56
|
|
|
CMV QUANT DNA PCR (PLASMA)
|
Facility
|
IP
|
$107.10
|
|
|
Service Code
|
HCPCS 87497
|
| Hospital Charge Code |
40619199
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$42.84
|
|
|
CNTRL POST EPISTAX, INIT
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
30103270
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$147.72
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
CNTRL POST EPISTAX, INIT
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
30103270
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
CNTRL POST EPISTAX, INIT
|
Facility
|
OP
|
$330.23
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
30302443
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$147.72
|
| Rate for Payer: Aetna Government |
$147.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$103.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$103.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$103.40
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Cash Price |
$147.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$147.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$131.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$147.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$131.47
|
| 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 |
$165.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$147.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$125.56
|
| Rate for Payer: Healthfirst QHP |
$147.72
|
| Rate for Payer: Humana Medicare |
$150.67
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$147.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$147.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$118.18
|
| Rate for Payer: Wellcare Medicare |
$140.33
|
|
|
CNTRL POST EPISTAX, INIT
|
Facility
|
IP
|
$330.23
|
|
|
Service Code
|
HCPCS 30905
|
| Hospital Charge Code |
30302443
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$147.72
|
|
|
CO2 CARTRIDGE
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
64907334
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.00
|
| Rate for Payer: Aetna Government |
$50.00
|
| Rate for Payer: Brighton Health Commercial |
$75.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$80.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.00
|
| Rate for Payer: Group Health Inc Commercial |
$50.00
|
| Rate for Payer: Group Health Inc Medicare |
$35.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
|
|
CO2 COMBINED
|
Facility
|
IP
|
$12.20
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
40602075
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$4.88
|
|
|
CO2 COMBINED
|
Facility
|
OP
|
$12.20
|
|
|
Service Code
|
HCPCS 82374
|
| Hospital Charge Code |
40602075
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.42 |
| Max. Negotiated Rate |
$9.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.88
|
| Rate for Payer: Aetna Government |
$4.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.42
|
| Rate for Payer: Brighton Health Commercial |
$9.15
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Cash Price |
$4.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$4.88
|
| Rate for Payer: EmblemHealth Commercial |
$4.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$4.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.34
|
| Rate for Payer: Group Health Inc Commercial |
$4.88
|
| Rate for Payer: Group Health Inc Medicare |
$4.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.88
|
| Rate for Payer: Healthfirst QHP |
$4.88
|
| Rate for Payer: Humana Medicare |
$4.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4.88
|
| Rate for Payer: United Healthcare Commercial |
$6.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.90
|
| Rate for Payer: Wellcare Medicare |
$4.39
|
|
|
COAGADEX (FACTOR X)
|
Facility
|
OP
|
$18.18
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
41640377
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.11
|
| Rate for Payer: Aetna Government |
$9.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.38
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.38
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.38
|
| Rate for Payer: Brighton Health Commercial |
$10.91
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.11
|
| Rate for Payer: EmblemHealth Commercial |
$9.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.57
|
| Rate for Payer: Group Health Inc Commercial |
$9.11
|
| Rate for Payer: Group Health Inc Medicare |
$9.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.75
|
| Rate for Payer: Healthfirst QHP |
$9.11
|
| Rate for Payer: Humana Medicare |
$9.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.66
|
| Rate for Payer: SOMOS Essential |
$9.66
|
| Rate for Payer: United Healthcare Commercial |
$8.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.29
|
| Rate for Payer: Wellcare Medicare |
$8.66
|
|
|
COAGADEX (FACTOR X)
|
Facility
|
IP
|
$18.18
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
41650377
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$9.09 |
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.09
|
|
|
COAGADEX (FACTOR X)
|
Facility
|
IP
|
$18.18
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
41640377
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$9.09 |
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.09
|
|
|
COAGADEX (FACTOR X)
|
Facility
|
OP
|
$18.18
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
41650377
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.11
|
| Rate for Payer: Aetna Government |
$9.11
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.38
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.38
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.38
|
| Rate for Payer: Brighton Health Commercial |
$10.91
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.11
|
| Rate for Payer: EmblemHealth Commercial |
$9.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.57
|
| Rate for Payer: Group Health Inc Commercial |
$9.11
|
| Rate for Payer: Group Health Inc Medicare |
$9.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.75
|
| Rate for Payer: Healthfirst QHP |
$9.11
|
| Rate for Payer: Humana Medicare |
$9.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.11
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$9.66
|
| Rate for Payer: SOMOS Essential |
$9.66
|
| Rate for Payer: United Healthcare Commercial |
$8.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.82
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.29
|
| Rate for Payer: Wellcare Medicare |
$8.66
|
|
|
COAGULATION DISORDERS
|
Facility
|
IP
|
$39,821.29
|
|
|
Service Code
|
MSDRG 813
|
| Min. Negotiated Rate |
$13,377.00 |
| Max. Negotiated Rate |
$39,821.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,002.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,960.94
|
| Rate for Payer: Aetna Government |
$28,960.94
|
| Rate for Payer: Brighton Health Commercial |
$22,620.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29,540.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26,939.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,231.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,512.89
|
| Rate for Payer: EmblemHealth Commercial |
$13,377.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,960.94
|
| Rate for Payer: Group Health Inc Commercial |
$28,960.94
|
| Rate for Payer: Group Health Inc Medicare |
$28,960.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,960.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,466.84
|
| Rate for Payer: Humana Medicare |
$39,821.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,960.94
|
| Rate for Payer: United Healthcare Commercial |
$31,023.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,960.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,960.94
|
| Rate for Payer: Wellcare Medicare |
$27,512.89
|
|
|
COAGULATION FACTOR X (HUMAN) 250 UNITS IV SOLR [131303]
|
Facility
|
OP
|
$13.66
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
64208775401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.11
|
| Rate for Payer: Aetna Government |
$9.11
|
| Rate for Payer: Brighton Health Commercial |
$8.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.11
|
| Rate for Payer: EmblemHealth Commercial |
$6.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.11
|
| Rate for Payer: Group Health Inc Commercial |
$9.11
|
| Rate for Payer: Group Health Inc Medicare |
$9.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.75
|
| Rate for Payer: Healthfirst QHP |
$9.11
|
| Rate for Payer: Humana Medicare |
$9.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.29
|
|
|
COAGULATION FACTOR X (HUMAN) 250 UNITS IV SOLR [131303]
|
Facility
|
OP
|
$13.66
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
64208775201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.11
|
| Rate for Payer: Aetna Government |
$9.11
|
| Rate for Payer: Brighton Health Commercial |
$8.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.11
|
| Rate for Payer: EmblemHealth Commercial |
$6.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.11
|
| Rate for Payer: Group Health Inc Commercial |
$9.11
|
| Rate for Payer: Group Health Inc Medicare |
$9.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.75
|
| Rate for Payer: Healthfirst QHP |
$9.11
|
| Rate for Payer: Humana Medicare |
$9.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.29
|
|
|
COAGULATION FACTOR X (HUMAN) 250 UNITS IV SOLR [131303]
|
Facility
|
IP
|
$13.66
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
64208775401
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.83
|
|
|
COAGULATION FACTOR X (HUMAN) 250 UNITS IV SOLR [131303]
|
Facility
|
IP
|
$13.66
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
64208775201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.83
|
|
|
COAGULATION FACTOR X (HUMAN) 500 UNITS IV SOLR [131304]
|
Facility
|
IP
|
$13.66
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
64208775301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.83
|
|
|
COAGULATION FACTOR X (HUMAN) 500 UNITS IV SOLR [131304]
|
Facility
|
OP
|
$13.66
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
64208775301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.11
|
| Rate for Payer: Aetna Government |
$9.11
|
| Rate for Payer: Brighton Health Commercial |
$8.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.11
|
| Rate for Payer: EmblemHealth Commercial |
$6.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.11
|
| Rate for Payer: Group Health Inc Commercial |
$9.11
|
| Rate for Payer: Group Health Inc Medicare |
$9.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.75
|
| Rate for Payer: Healthfirst QHP |
$9.11
|
| Rate for Payer: Humana Medicare |
$9.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.29
|
|
|
COAGULATION FACTOR X (HUMAN) 500 UNITS IV SOLR [131304]
|
Facility
|
IP
|
$13.66
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
64208775601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.83
|
|
|
COAGULATION FACTOR X (HUMAN) 500 UNITS IV SOLR [131304]
|
Facility
|
OP
|
$13.66
|
|
|
Service Code
|
HCPCS J7175
|
| Hospital Charge Code |
64208775601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.11
|
| Rate for Payer: Aetna Government |
$9.11
|
| Rate for Payer: Brighton Health Commercial |
$8.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.11
|
| Rate for Payer: EmblemHealth Commercial |
$6.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.11
|
| Rate for Payer: Group Health Inc Commercial |
$9.11
|
| Rate for Payer: Group Health Inc Medicare |
$9.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.75
|
| Rate for Payer: Healthfirst QHP |
$9.11
|
| Rate for Payer: Humana Medicare |
$9.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.29
|
|
|
COAGULATOR HANDSWITCHING SUCTION
|
Facility
|
OP
|
$30.20
|
|
| Hospital Charge Code |
64903052
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$24.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.10
|
| Rate for Payer: Aetna Government |
$15.10
|
| Rate for Payer: Brighton Health Commercial |
$22.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.54
|
| Rate for Payer: Group Health Inc Commercial |
$15.10
|
| Rate for Payer: Group Health Inc Medicare |
$10.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.10
|
|
|
COAGULATOR,SUCTION,FOOTSWITCH 10F
|
Facility
|
OP
|
$22.79
|
|
| Hospital Charge Code |
64906133
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.40
|
| Rate for Payer: Aetna Government |
$11.40
|
| Rate for Payer: Brighton Health Commercial |
$17.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.50
|
| Rate for Payer: Group Health Inc Commercial |
$11.40
|
| Rate for Payer: Group Health Inc Medicare |
$7.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.40
|
|
|
COAGULATOR,SUCTION,HAND SW 10FR
|
Facility
|
OP
|
$23.61
|
|
| Hospital Charge Code |
64905957
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$18.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.80
|
| Rate for Payer: Aetna Government |
$11.80
|
| Rate for Payer: Brighton Health Commercial |
$17.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.05
|
| Rate for Payer: Group Health Inc Commercial |
$11.80
|
| Rate for Payer: Group Health Inc Medicare |
$8.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.80
|
|
