|
DOXORUBICIN 200 MG/100 ML INJ
|
Facility
IP
|
$4.84
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41644760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.42
|
|
|
DOXORUBICIN 200 MG/100 ML INJ
|
Facility
IP
|
$4.84
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41654760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.42
|
|
|
DOXORUBICIN 200 MG/100 ML INJ
|
Facility
OP
|
$4.84
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41644760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.78
|
| Rate for Payer: Group Health Inc Commercial |
$2.42
|
| Rate for Payer: Group Health Inc Medicare |
$1.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.15
|
|
|
DOXORUBICIN 200 MG/100 ML INJ
|
Facility
OP
|
$4.84
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41654760
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.78
|
| Rate for Payer: Group Health Inc Commercial |
$2.42
|
| Rate for Payer: Group Health Inc Medicare |
$1.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.15
|
|
|
DOXORUBICIN 50 MG/25 ML INJ
|
Facility
IP
|
$4.12
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41644946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.06
|
|
|
DOXORUBICIN 50 MG/25 ML INJ
|
Facility
IP
|
$4.12
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41654946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.06
|
|
|
DOXORUBICIN 50 MG/25 ML INJ
|
Facility
OP
|
$4.12
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41654946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.37
|
| Rate for Payer: Group Health Inc Commercial |
$2.06
|
| Rate for Payer: Group Health Inc Medicare |
$1.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.68
|
|
|
DOXORUBICIN 50 MG/25 ML INJ
|
Facility
OP
|
$4.12
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41644946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.37
|
| Rate for Payer: Group Health Inc Commercial |
$2.06
|
| Rate for Payer: Group Health Inc Medicare |
$1.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.68
|
|
|
DOXORUBICIN 50 MG INJ
|
Facility
IP
|
$4.84
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41653586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.42
|
|
|
DOXORUBICIN 50 MG INJ
|
Facility
IP
|
$4.84
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41643586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$2.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.42
|
|
|
DOXORUBICIN 50 MG INJ
|
Facility
OP
|
$4.84
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41653586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.78
|
| Rate for Payer: Group Health Inc Commercial |
$2.42
|
| Rate for Payer: Group Health Inc Medicare |
$1.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.15
|
|
|
DOXORUBICIN 50 MG INJ
|
Facility
OP
|
$4.84
|
|
|
Service Code
|
HCPCS J9000
|
| Hospital Charge Code |
41643586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.78
|
| Rate for Payer: Group Health Inc Commercial |
$2.42
|
| Rate for Payer: Group Health Inc Medicare |
$1.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.15
|
|
|
DOXYCYCLINE 100 MG CAP
|
Facility
OP
|
$0.14
|
|
| Hospital Charge Code |
41644706
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
|
DOXYCYCLINE 100 MG CAP
|
Facility
OP
|
$0.14
|
|
| Hospital Charge Code |
41654706
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
|
DOXYCYCLINE 100 MG INJ
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
41653434
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.00
|
| Rate for Payer: Aetna Government |
$19.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.84
|
| Rate for Payer: Group Health Inc Commercial |
$19.00
|
| Rate for Payer: Group Health Inc Medicare |
$13.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.70
|
|
|
DOXYCYCLINE 100 MG INJ
|
Facility
OP
|
$38.00
|
|
| Hospital Charge Code |
41643434
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.00
|
| Rate for Payer: Aetna Government |
$19.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.84
|
| Rate for Payer: Group Health Inc Commercial |
$19.00
|
| Rate for Payer: Group Health Inc Medicare |
$13.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.70
|
|
|
DR ABSC/HEMATOMA, NASAL, INT
|
Facility
OP
|
$620.33
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
30307891
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.22 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| 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 |
$310.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$150.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.10
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
DR ABSC/HEMATOMA, NASAL, INT
|
Facility
OP
|
$620.33
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
30103310
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.22 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$282.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| 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 |
$310.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
DRAGERSORB CLICK
|
Facility
OP
|
$32.99
|
|
| Hospital Charge Code |
64901065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$26.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.50
|
| Rate for Payer: Aetna Government |
$16.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.43
|
| Rate for Payer: Group Health Inc Commercial |
$16.50
|
| Rate for Payer: Group Health Inc Medicare |
$11.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.50
|
|
|
DRAIN ABSCESS OF EYELID
|
Facility
OP
|
$819.25
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
30105795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$336.88
|
| Rate for Payer: Aetna Government |
$336.88
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$336.88
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.88
|
| 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 |
$336.88
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.82
|
| 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 |
$409.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$336.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.50
|
| Rate for Payer: Wellcare Medicare |
$320.04
|
|
|
DRAIN ABSCESS PALATE, UVULA
|
Facility
OP
|
$616.78
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
30105794
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.13 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$282.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| 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 |
$308.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
DRAIN ABSESS OF EYELID
|
Facility
OP
|
$819.25
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
30305795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$336.88
|
| Rate for Payer: Aetna Government |
$336.88
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$336.88
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.88
|
| 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 |
$336.88
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$123.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.82
|
| 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 |
$409.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$336.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.50
|
| Rate for Payer: Wellcare Medicare |
$320.04
|
|
|
DRAIN ABSESS PALATE, UVULA
|
Facility
OP
|
$616.78
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
30305794
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$121.13 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$282.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$121.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| 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 |
$308.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
DRAINAGE BAG
|
Facility
OP
|
$9.57
|
|
| Hospital Charge Code |
40201222
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
DRAINAGE,EXT CANAL/ABCESS
|
Facility
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 69020
|
| Hospital Charge Code |
30304098
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.87 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| 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 |
$813.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$160.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| 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 |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$178.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$813.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
