CUTTER 38 WIDE STAINLESS STELL RL
|
Facility
|
OP
|
$1,791.43
|
|
Hospital Charge Code |
64905299
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$627.00 |
Max. Negotiated Rate |
$1,433.14 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$985.29
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$895.72
|
Rate for Payer: Aetna Government |
$895.72
|
Rate for Payer: Brighton Health Commercial |
$1,343.57
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,433.14
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,218.17
|
Rate for Payer: Group Health Inc Commercial |
$895.72
|
Rate for Payer: Group Health Inc Medicare |
$627.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$895.72
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$895.72
|
|
CUTTER 4MM AGREESIVE + FORM
|
Facility
|
OP
|
$100.00
|
|
Hospital Charge Code |
64904964
|
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
|
|
CUTTER 5.5MM AGRRESIVE
|
Facility
|
OP
|
$188.25
|
|
Hospital Charge Code |
64904968
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$65.89 |
Max. Negotiated Rate |
$150.60 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$103.54
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$94.12
|
Rate for Payer: Aetna Government |
$94.12
|
Rate for Payer: Brighton Health Commercial |
$141.19
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$150.60
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$128.01
|
Rate for Payer: Group Health Inc Commercial |
$94.12
|
Rate for Payer: Group Health Inc Medicare |
$65.89
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$94.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$94.12
|
|
CUTTER, FLIP II 9.0MM
|
Facility
|
OP
|
$812.50
|
|
Hospital Charge Code |
64905555
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$284.38 |
Max. Negotiated Rate |
$650.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$446.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$406.25
|
Rate for Payer: Aetna Government |
$406.25
|
Rate for Payer: Brighton Health Commercial |
$609.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$650.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$552.50
|
Rate for Payer: Group Health Inc Commercial |
$406.25
|
Rate for Payer: Group Health Inc Medicare |
$284.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$406.25
|
|
CUTTER, FLIP II 9.5MM
|
Facility
|
OP
|
$812.50
|
|
Hospital Charge Code |
64905866
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$284.38 |
Max. Negotiated Rate |
$650.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$446.88
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$406.25
|
Rate for Payer: Aetna Government |
$406.25
|
Rate for Payer: Brighton Health Commercial |
$609.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$650.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$552.50
|
Rate for Payer: Group Health Inc Commercial |
$406.25
|
Rate for Payer: Group Health Inc Medicare |
$284.38
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$406.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$406.25
|
|
CUTTER FORMULA AGG 5.5MM
|
Facility
|
OP
|
$56.10
|
|
Hospital Charge Code |
64906049
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$19.64 |
Max. Negotiated Rate |
$44.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.86
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.05
|
Rate for Payer: Aetna Government |
$28.05
|
Rate for Payer: Brighton Health Commercial |
$42.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.15
|
Rate for Payer: Group Health Inc Commercial |
$28.05
|
Rate for Payer: Group Health Inc Medicare |
$19.64
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.05
|
|
CUTTER FORMULA TOM 5.5X12.5
|
Facility
|
OP
|
$11.22
|
|
Hospital Charge Code |
64906050
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$3.93 |
Max. Negotiated Rate |
$8.98 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.17
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.61
|
Rate for Payer: Aetna Government |
$5.61
|
Rate for Payer: Brighton Health Commercial |
$8.42
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.98
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.63
|
Rate for Payer: Group Health Inc Commercial |
$5.61
|
Rate for Payer: Group Health Inc Medicare |
$3.93
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.61
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$5.61
|
|
CUTTER FORMULA TOMCAT 4MM
|
Facility
|
OP
|
$56.10
|
|
Hospital Charge Code |
64906048
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$19.64 |
Max. Negotiated Rate |
$44.88 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.86
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28.05
|
Rate for Payer: Aetna Government |
$28.05
|
Rate for Payer: Brighton Health Commercial |
$42.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.88
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.15
|
Rate for Payer: Group Health Inc Commercial |
$28.05
|
Rate for Payer: Group Health Inc Medicare |
$19.64
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.05
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$28.05
|
|
CUTTER II 7.5 FLIP
|
Facility
|
OP
|
$1,162.50
|
|
Hospital Charge Code |
64905942
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$406.88 |
Max. Negotiated Rate |
$930.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$639.38
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$581.25
|
Rate for Payer: Aetna Government |
$581.25
|
Rate for Payer: Brighton Health Commercial |
$871.88
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$930.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$790.50
|
Rate for Payer: Group Health Inc Commercial |
$581.25
|
Rate for Payer: Group Health Inc Medicare |
$406.88
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$581.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$581.25
|
|
CUTTER LINEAR
|
Facility
|
OP
|
$242.74
|
|
Hospital Charge Code |
64902973
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$84.96 |
Max. Negotiated Rate |
$194.19 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$133.51
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$121.37
|
Rate for Payer: Aetna Government |
$121.37
|
Rate for Payer: Brighton Health Commercial |
$182.06
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$194.19
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$165.06
|
Rate for Payer: Group Health Inc Commercial |
$121.37
|
Rate for Payer: Group Health Inc Medicare |
$84.96
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.37
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$121.37
|
|
CUTTER,LINEAR,75MM,SAFETYLOCKOUT
|
Facility
|
OP
|
$362.25
|
|
Hospital Charge Code |
64902972
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$126.79 |
Max. Negotiated Rate |
$289.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$199.24
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$181.12
|
Rate for Payer: Aetna Government |
$181.12
|
Rate for Payer: Brighton Health Commercial |
$271.69
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$289.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$246.33
|
Rate for Payer: Group Health Inc Commercial |
$181.12
|
Rate for Payer: Group Health Inc Medicare |
$126.79
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$181.12
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$181.12
|
|
CUTTER LINEAR PROX 55MM RELOAD
|
Facility
|
OP
|
$143.58
|
|
Hospital Charge Code |
64904646
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$50.25 |
Max. Negotiated Rate |
$114.86 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$78.97
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$71.79
|
Rate for Payer: Aetna Government |
$71.79
|
Rate for Payer: Brighton Health Commercial |
$107.68
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$114.86
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$97.63
|
Rate for Payer: Group Health Inc Commercial |
$71.79
|
Rate for Payer: Group Health Inc Medicare |
$50.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$71.79
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$71.79
|
|
CUTTER,LINEAR,RELOAD,ENDO,WHITE
|
Facility
|
OP
|
$268.91
|
|
Hospital Charge Code |
64902986
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$94.12 |
Max. Negotiated Rate |
$215.13 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$147.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.46
|
Rate for Payer: Aetna Government |
$134.46
|
Rate for Payer: Brighton Health Commercial |
$201.68
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$215.13
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$182.86
|
Rate for Payer: Group Health Inc Commercial |
$134.46
|
Rate for Payer: Group Health Inc Medicare |
$94.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$134.46
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$134.46
|
|
CUTTER LINR ENDO THORAC 45MM THIK
|
Facility
|
OP
|
$1,608.48
|
|
Hospital Charge Code |
40200408
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$562.97 |
Max. Negotiated Rate |
$1,286.78 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$884.66
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$804.24
|
Rate for Payer: Aetna Government |
$804.24
|
Rate for Payer: Brighton Health Commercial |
$1,206.36
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,286.78
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,093.77
|
Rate for Payer: Group Health Inc Commercial |
$804.24
|
Rate for Payer: Group Health Inc Medicare |
$562.97
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$804.24
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$804.24
|
|
CUTTER SMALL JOINT AG
|
Facility
|
OP
|
$500.00
|
|
Hospital Charge Code |
64905884
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$175.00 |
Max. Negotiated Rate |
$400.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$275.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$250.00
|
Rate for Payer: Aetna Government |
$250.00
|
Rate for Payer: Brighton Health Commercial |
$375.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$400.00
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$340.00
|
Rate for Payer: Group Health Inc Commercial |
$250.00
|
Rate for Payer: Group Health Inc Medicare |
$175.00
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$250.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$250.00
|
|
CUTTER VASCULAR RED
|
Facility
|
OP
|
$257.60
|
|
Hospital Charge Code |
64902995
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$90.16 |
Max. Negotiated Rate |
$206.08 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$141.68
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$128.80
|
Rate for Payer: Aetna Government |
$128.80
|
Rate for Payer: Brighton Health Commercial |
$193.20
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$206.08
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$175.17
|
Rate for Payer: Group Health Inc Commercial |
$128.80
|
Rate for Payer: Group Health Inc Medicare |
$90.16
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$128.80
|
|
CUTTING & BENDING PLIERS
|
Facility
|
OP
|
$318.00
|
|
Hospital Charge Code |
40200643
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$111.30 |
Max. Negotiated Rate |
$254.40 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$174.90
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$159.00
|
Rate for Payer: Aetna Government |
$159.00
|
Rate for Payer: Brighton Health Commercial |
$238.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$254.40
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$216.24
|
Rate for Payer: Group Health Inc Commercial |
$159.00
|
Rate for Payer: Group Health Inc Medicare |
$111.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$159.00
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$159.00
|
|
CVP INSERTION
|
Facility
|
OP
|
$1,909.65
|
|
Service Code
|
HCPCS 36568
|
Hospital Charge Code |
40000030
|
Hospital Revenue Code
|
360
|
Min. Negotiated Rate |
$954.82 |
Max. Negotiated Rate |
$2,915.00 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,852.05
|
Rate for Payer: Aetna Government |
$1,852.05
|
Rate for Payer: Affinity Essential Plan 1&2 |
$1,296.44
|
Rate for Payer: Affinity Essential Plan 3&4 |
$1,296.44
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,296.44
|
Rate for Payer: Brighton Health Commercial |
$1,432.24
|
Rate for Payer: Cash Price |
$1,852.05
|
Rate for Payer: Cash Price |
$1,852.05
|
Rate for Payer: Cash Price |
$1,852.05
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,852.05
|
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 |
$1,852.05
|
Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$1,574.24
|
Rate for Payer: Fidelis Essential Plan QHP |
$1,648.32
|
Rate for Payer: Fidelis Medicare Advantage |
$1,852.05
|
Rate for Payer: Fidelis Qualified Health Plan |
$1,648.32
|
Rate for Payer: Group Health Inc Commercial |
$1,852.05
|
Rate for Payer: Group Health Inc Medicare |
$1,852.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.82
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1,852.05
|
Rate for Payer: Healthfirst Medicare Advantage |
$1,574.24
|
Rate for Payer: Healthfirst QHP |
$1,852.05
|
Rate for Payer: Humana Medicare |
$1,889.09
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$1,852.05
|
Rate for Payer: United Healthcare Commercial |
$1,188.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$1,852.05
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,852.05
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,481.64
|
Rate for Payer: Wellcare Medicare |
$1,759.45
|
|
CVP INSERTION
|
Facility
|
IP
|
$1,909.65
|
|
Service Code
|
HCPCS 36568
|
Hospital Charge Code |
40000030
|
Hospital Revenue Code
|
360
|
Rate for Payer: Cash Price |
$1,852.05
|
|
CVP Monitor
|
Facility
|
OP
|
$53.51
|
|
Hospital Charge Code |
40200980
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$18.73 |
Max. Negotiated Rate |
$42.81 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.43
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.76
|
Rate for Payer: Aetna Government |
$26.76
|
Rate for Payer: Brighton Health Commercial |
$40.13
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.81
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.39
|
Rate for Payer: Group Health Inc Commercial |
$26.76
|
Rate for Payer: Group Health Inc Medicare |
$18.73
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.76
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$26.76
|
|
CVR BURRHOLE LW PROF 14MM W/TAB
|
Facility
|
OP
|
$473.35
|
|
Hospital Charge Code |
64904587
|
Hospital Revenue Code
|
270
|
Min. Negotiated Rate |
$165.67 |
Max. Negotiated Rate |
$378.68 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$260.34
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$236.68
|
Rate for Payer: Aetna Government |
$236.68
|
Rate for Payer: Brighton Health Commercial |
$355.01
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$378.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$321.88
|
Rate for Payer: Group Health Inc Commercial |
$236.68
|
Rate for Payer: Group Health Inc Medicare |
$165.67
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$236.68
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$236.68
|
|
CYANIDE OCC EXPOSURE, BI
|
Facility
|
OP
|
$48.50
|
|
Service Code
|
HCPCS 82600
|
Hospital Charge Code |
40609890
|
Hospital Revenue Code
|
301
|
Min. Negotiated Rate |
$13.58 |
Max. Negotiated Rate |
$36.38 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.68
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.40
|
Rate for Payer: Aetna Government |
$19.40
|
Rate for Payer: Affinity Essential Plan 1&2 |
$13.58
|
Rate for Payer: Affinity Essential Plan 3&4 |
$13.58
|
Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.58
|
Rate for Payer: Brighton Health Commercial |
$36.38
|
Rate for Payer: Cash Price |
$19.40
|
Rate for Payer: Cash Price |
$19.40
|
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.40
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.85
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.10
|
Rate for Payer: Elderplan Medicare Advantage |
$19.40
|
Rate for Payer: EmblemHealth Commercial |
$19.40
|
Rate for Payer: Fidelis Essential Plan Aliesa |
$16.49
|
Rate for Payer: Fidelis Essential Plan QHP |
$17.27
|
Rate for Payer: Fidelis Medicare Advantage |
$19.40
|
Rate for Payer: Fidelis Qualified Health Plan |
$17.27
|
Rate for Payer: Group Health Inc Commercial |
$19.40
|
Rate for Payer: Group Health Inc Medicare |
$19.40
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.25
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$19.40
|
Rate for Payer: Healthfirst Medicare Advantage |
$19.40
|
Rate for Payer: Healthfirst QHP |
$19.40
|
Rate for Payer: Humana Medicare |
$19.79
|
Rate for Payer: Senior Whole Health Medicare Advantage |
$19.40
|
Rate for Payer: United Healthcare Commercial |
$24.57
|
Rate for Payer: United Healthcare Medicare Advantage |
$19.40
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.40
|
Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.52
|
Rate for Payer: Wellcare Medicare |
$17.46
|
|
CYANIDE OCC EXPOSURE, BI
|
Facility
|
IP
|
$48.50
|
|
Service Code
|
HCPCS 82600
|
Hospital Charge Code |
40609890
|
Hospital Revenue Code
|
301
|
Rate for Payer: Cash Price |
$19.40
|
|
CYANOCOBALAMIN 1000 MCG INJ
|
Facility
|
IP
|
$3.04
|
|
Service Code
|
HCPCS J3420
|
Hospital Charge Code |
41644513
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.52 |
Max. Negotiated Rate |
$1.52 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.52
|
|
CYANOCOBALAMIN 1000 MCG INJ
|
Facility
|
OP
|
$3.04
|
|
Service Code
|
HCPCS J3420
|
Hospital Charge Code |
41644513
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$1.06 |
Max. Negotiated Rate |
$2.12 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.67
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.12
|
Rate for Payer: Aetna Government |
$2.12
|
Rate for Payer: Brighton Health Commercial |
$1.82
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.52
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.75
|
Rate for Payer: Group Health Inc Commercial |
$1.52
|
Rate for Payer: Group Health Inc Medicare |
$1.06
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.52
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$1.52
|
Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.51
|
Rate for Payer: SOMOS Essential |
$1.51
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.98
|
|