|
ADO-TRASTUZUMAB EMTANSINE 100 MG IV SOLR [120086]
|
Facility
|
IP
|
$4,670.10
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
50242008801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,335.05 |
| Max. Negotiated Rate |
$2,335.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,335.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,335.05
|
|
|
ADO-TRASTUZUMAB EMTANSINE 100 MG IV SOLR [120086]
|
Facility
|
OP
|
$4,670.10
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
50242008801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$3,035.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,568.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.37
|
| Rate for Payer: Aetna Government |
$38.37
|
| Rate for Payer: Brighton Health Commercial |
$2,802.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,335.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,685.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.37
|
| Rate for Payer: EmblemHealth Commercial |
$2,335.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.37
|
| Rate for Payer: Group Health Inc Commercial |
$38.37
|
| Rate for Payer: Group Health Inc Medicare |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,335.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,335.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.61
|
| Rate for Payer: Healthfirst QHP |
$38.37
|
| Rate for Payer: Humana Medicare |
$39.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,035.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.69
|
|
|
ADO-TRASTUZUMAB EMTANSINE 160 MG IV SOLR [120087]
|
Facility
|
IP
|
$7,472.15
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
50242008701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.08 |
| Max. Negotiated Rate |
$3,736.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,736.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,736.08
|
|
|
ADO-TRASTUZUMAB EMTANSINE 160 MG IV SOLR [120087]
|
Facility
|
OP
|
$7,472.15
|
|
|
Service Code
|
HCPCS J9354
|
| Hospital Charge Code |
50242008701
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$4,856.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,109.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.37
|
| Rate for Payer: Aetna Government |
$38.37
|
| Rate for Payer: Brighton Health Commercial |
$4,483.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,736.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,296.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$38.37
|
| Rate for Payer: EmblemHealth Commercial |
$3,736.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$38.37
|
| Rate for Payer: Group Health Inc Commercial |
$38.37
|
| Rate for Payer: Group Health Inc Medicare |
$38.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,736.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,736.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$32.61
|
| Rate for Payer: Healthfirst QHP |
$38.37
|
| Rate for Payer: Humana Medicare |
$39.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,856.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.69
|
|
|
ADPT OSTMY BLT LG 34-65 86-165CM
|
Facility
|
OP
|
$32.20
|
|
|
Service Code
|
HCPCS A4387
|
| Hospital Charge Code |
40005167
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.36
|
| Rate for Payer: Aetna Government |
$1.36
|
| Rate for Payer: Brighton Health Commercial |
$24.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.90
|
| Rate for Payer: Group Health Inc Commercial |
$16.10
|
| Rate for Payer: Group Health Inc Medicare |
$11.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.10
|
|
|
ADPT OSTMY BLT MD 23-43 58-109CM
|
Facility
|
OP
|
$32.20
|
|
|
Service Code
|
HCPCS A4387
|
| Hospital Charge Code |
40005168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.36
|
| Rate for Payer: Aetna Government |
$1.36
|
| Rate for Payer: Brighton Health Commercial |
$24.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.90
|
| Rate for Payer: Group Health Inc Commercial |
$16.10
|
| Rate for Payer: Group Health Inc Medicare |
$11.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.10
|
|
|
ADPT OVL CVX RNG1-3/16X1-7/8
|
Facility
|
OP
|
$43.90
|
|
|
Service Code
|
HCPCS A4411
|
| Hospital Charge Code |
40005181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.10
|
| Rate for Payer: Aetna Government |
$3.10
|
| Rate for Payer: Brighton Health Commercial |
$32.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.85
|
| Rate for Payer: Group Health Inc Commercial |
$21.95
|
| Rate for Payer: Group Health Inc Medicare |
$15.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.95
|
|
|
ADPT OVL RNG7/8X1-1/2 22X38MM
|
Facility
|
OP
|
$43.90
|
|
|
Service Code
|
HCPCS A4411
|
| Hospital Charge Code |
40005180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$35.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.10
|
| Rate for Payer: Aetna Government |
$3.10
|
| Rate for Payer: Brighton Health Commercial |
$32.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.85
|
| Rate for Payer: Group Health Inc Commercial |
$21.95
|
| Rate for Payer: Group Health Inc Medicare |
$15.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.95
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$53,023.77
|
|
|
Service Code
|
MSDRG 614
|
| Min. Negotiated Rate |
$17,931.67 |
| Max. Negotiated Rate |
$53,023.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33,211.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,562.74
|
| Rate for Payer: Aetna Government |
$38,562.74
|
| Rate for Payer: Brighton Health Commercial |
$32,659.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,333.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38,896.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32,099.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,634.60
|
| Rate for Payer: EmblemHealth Commercial |
$19,314.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,562.74
|
| Rate for Payer: Group Health Inc Commercial |
$38,562.74
|
| Rate for Payer: Group Health Inc Medicare |
$38,562.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,562.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,931.67
|
| Rate for Payer: Humana Medicare |
$53,023.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,562.74
|
| Rate for Payer: United Healthcare Commercial |
$44,793.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,562.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,562.74
|
| Rate for Payer: Wellcare Medicare |
$36,634.60
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$38,126.19
|
|
|
Service Code
|
MSDRG 615
|
| Min. Negotiated Rate |
$12,614.70 |
| Max. Negotiated Rate |
$38,126.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,691.37
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,728.14
|
| Rate for Payer: Aetna Government |
$27,728.14
|
| Rate for Payer: Brighton Health Commercial |
$21,330.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,282.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,404.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,964.82
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,341.73
|
| Rate for Payer: EmblemHealth Commercial |
$12,614.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,728.14
|
| Rate for Payer: Group Health Inc Commercial |
$27,728.14
|
| Rate for Payer: Group Health Inc Medicare |
$27,728.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,728.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,893.59
|
| Rate for Payer: Humana Medicare |
$38,126.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,728.14
|
| Rate for Payer: United Healthcare Commercial |
$29,255.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,728.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,728.14
|
| Rate for Payer: Wellcare Medicare |
$26,341.73
|
|
|
ADULT LANYNYOSCOPY TRAY
|
Facility
|
OP
|
$7,500.00
|
|
| Hospital Charge Code |
64905987
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2,625.00 |
| Max. Negotiated Rate |
$6,000.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,125.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,750.00
|
| Rate for Payer: Aetna Government |
$3,750.00
|
| Rate for Payer: Brighton Health Commercial |
$5,625.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,100.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,750.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,625.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,750.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,750.00
|
|
|
ADVANCE CARE PLAN IN RCRD
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS 1157F
|
| Hospital Charge Code |
30305808
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
ADVANCE MALE SLING SYSTEM
|
Facility
|
IP
|
$12,462.56
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
40204570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,231.28 |
| Max. Negotiated Rate |
$6,231.28 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,231.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,231.28
|
|
|
ADVANCE MALE SLING SYSTEM
|
Facility
|
OP
|
$12,462.56
|
|
|
Service Code
|
HCPCS C1771
|
| Hospital Charge Code |
40204570
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.38 |
| Max. Negotiated Rate |
$13,085.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,854.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$560.38
|
| Rate for Payer: Aetna Government |
$560.38
|
| Rate for Payer: Brighton Health Commercial |
$7,477.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,231.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,165.97
|
| Rate for Payer: EmblemHealth Commercial |
$6,231.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,085.69
|
| Rate for Payer: Group Health Inc Commercial |
$6,231.28
|
| Rate for Payer: Group Health Inc Medicare |
$4,361.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,231.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,231.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,100.66
|
|
|
ADVANIX DUODENAL BLD PRELOADED
|
Facility
|
OP
|
$565.73
|
|
| Hospital Charge Code |
64905330
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$198.01 |
| Max. Negotiated Rate |
$452.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$311.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.86
|
| Rate for Payer: Aetna Government |
$282.86
|
| Rate for Payer: Brighton Health Commercial |
$424.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$452.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$384.70
|
| Rate for Payer: Group Health Inc Commercial |
$282.86
|
| Rate for Payer: Group Health Inc Medicare |
$198.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$282.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.86
|
|
|
ADVISA DR PACEMAKER MODEL- A2DR01
|
Facility
|
OP
|
$14,814.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
66573200
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$15,554.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8,147.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.42
|
| Rate for Payer: Aetna Government |
$275.42
|
| Rate for Payer: Brighton Health Commercial |
$8,888.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7,407.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8,518.05
|
| Rate for Payer: EmblemHealth Commercial |
$7,407.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$15,554.70
|
| Rate for Payer: Group Health Inc Commercial |
$7,407.00
|
| Rate for Payer: Group Health Inc Medicare |
$5,184.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,407.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,407.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,629.10
|
|
|
ADVNC CARE PLAN TLK DOCD
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS 1158F
|
| Hospital Charge Code |
30305809
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
AEROCHAMBER INHALER 1X
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
40305405
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
AEROCHAMBER INHALER 1X
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
40305908
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
AEROCHAMBER INHALER 1X
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
40305405
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
AEROCHAMBER INHALER 1X
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
40305908
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
AEROCHAMBER INHALER BID
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
40305420
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
AEROCHAMBER INHALER BID
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
40305420
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
AEROCHAMBER INHALER TID
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
40305415
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
AEROCHAMBER INHALER TID
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94664
|
| Hospital Charge Code |
40305415
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
