|
DESMOPRESSIN 4 MCG/ML INJ 10 ML
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41641285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.43
|
| Rate for Payer: Brighton Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.64
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.65
|
| Rate for Payer: SOMOS Essential |
$6.65
|
| Rate for Payer: United Healthcare Commercial |
$7.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 10 ML
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41641285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 10 ML
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41651285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 10 ML
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41651285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.43
|
| Rate for Payer: Brighton Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.64
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.65
|
| Rate for Payer: SOMOS Essential |
$6.65
|
| Rate for Payer: United Healthcare Commercial |
$7.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 1 ML
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41643941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 1 ML
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41643941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.43
|
| Rate for Payer: Brighton Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.64
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.65
|
| Rate for Payer: SOMOS Essential |
$6.65
|
| Rate for Payer: United Healthcare Commercial |
$7.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 1 ML
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41653941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.43
|
| Rate for Payer: Brighton Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.64
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$6.65
|
| Rate for Payer: SOMOS Essential |
$6.65
|
| Rate for Payer: United Healthcare Commercial |
$7.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN 4 MCG/ML INJ 1 ML
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
41653941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Cash Price |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.50
|
|
|
DESMOPRESSIN ACETATE 0.1 MG PO TABS [16052]
|
Facility
|
OP
|
$5.29
|
|
|
Service Code
|
NDC 69918010101
|
| Hospital Charge Code |
69918010101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.64
|
| Rate for Payer: Aetna Government |
$2.64
|
| Rate for Payer: Brighton Health Commercial |
$3.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.59
|
| Rate for Payer: Group Health Inc Commercial |
$2.64
|
| Rate for Payer: Group Health Inc Medicare |
$1.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.44
|
|
|
DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN [9748]
|
Facility
|
OP
|
$71.42
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
69918090110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$57.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.43
|
| Rate for Payer: Brighton Health Commercial |
$53.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.63
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN [9748]
|
Facility
|
OP
|
$71.42
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
00703505103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$57.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.43
|
| Rate for Payer: Brighton Health Commercial |
$53.57
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.63
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN [9748]
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
43598005311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.43
|
| Rate for Payer: Brighton Health Commercial |
$47.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.63
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN [9748]
|
Facility
|
OP
|
$71.32
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
62756052940
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$57.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.43
|
| Rate for Payer: Brighton Health Commercial |
$53.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$57.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$48.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.63
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN [9748]
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
70860045441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.43
|
| Rate for Payer: Brighton Health Commercial |
$47.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.63
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN [9748]
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
70860045410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.43
|
| Rate for Payer: Brighton Health Commercial |
$47.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.63
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN [177319]
|
Facility
|
OP
|
$70.55
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
69918089901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$56.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.33
|
| Rate for Payer: Aetna Government |
$6.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.43
|
| Rate for Payer: Brighton Health Commercial |
$52.91
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.33
|
| Rate for Payer: EmblemHealth Commercial |
$6.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.63
|
| Rate for Payer: Group Health Inc Commercial |
$6.33
|
| Rate for Payer: Group Health Inc Medicare |
$6.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.38
|
| Rate for Payer: Healthfirst QHP |
$6.33
|
| Rate for Payer: Humana Medicare |
$6.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$6.27
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$6.65
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$6.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.06
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN [21135]
|
Facility
|
OP
|
$49.25
|
|
|
Service Code
|
NDC 60505081500
|
| Hospital Charge Code |
60505081500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.24 |
| Max. Negotiated Rate |
$39.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.62
|
| Rate for Payer: Aetna Government |
$24.62
|
| Rate for Payer: Brighton Health Commercial |
$36.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.49
|
| Rate for Payer: Group Health Inc Commercial |
$24.62
|
| Rate for Payer: Group Health Inc Medicare |
$17.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.01
|
|
|
DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN [21135]
|
Facility
|
OP
|
$49.25
|
|
|
Service Code
|
NDC 47335078891
|
| Hospital Charge Code |
47335078891
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.24 |
| Max. Negotiated Rate |
$39.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.62
|
| Rate for Payer: Aetna Government |
$24.62
|
| Rate for Payer: Brighton Health Commercial |
$36.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.49
|
| Rate for Payer: Group Health Inc Commercial |
$24.62
|
| Rate for Payer: Group Health Inc Medicare |
$17.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32.01
|
|
|
DESMOPRESSIN NASAL SPRAY 0.01%
|
Facility
|
OP
|
$378.18
|
|
| Hospital Charge Code |
41643938
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$132.36 |
| Max. Negotiated Rate |
$302.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$208.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$189.09
|
| Rate for Payer: Aetna Government |
$189.09
|
| Rate for Payer: Brighton Health Commercial |
$283.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$302.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$257.16
|
| Rate for Payer: Group Health Inc Commercial |
$189.09
|
| Rate for Payer: Group Health Inc Medicare |
$132.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.82
|
|
|
DESMOPRESSIN NASAL SPRAY 0.01%
|
Facility
|
OP
|
$378.18
|
|
| Hospital Charge Code |
41653938
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$132.36 |
| Max. Negotiated Rate |
$302.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$208.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$189.09
|
| Rate for Payer: Aetna Government |
$189.09
|
| Rate for Payer: Brighton Health Commercial |
$283.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$302.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$257.16
|
| Rate for Payer: Group Health Inc Commercial |
$189.09
|
| Rate for Payer: Group Health Inc Medicare |
$132.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$189.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.82
|
|
|
DEST BY NEUR AGENT CER/THOR EA AD
|
Facility
|
OP
|
$457.25
|
|
|
Service Code
|
HCPCS 64634
|
| Hospital Charge Code |
30305738
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.07 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78.07
|
| Rate for Payer: Aetna Government |
$78.07
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.62
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
DEST BY NEUR AGENT LUMB/SAC SINGL
|
Facility
|
IP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
30305739
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$2,232.80
|
|
|
DEST BY NEUR AGENT LUMB/SAC SINGL
|
Facility
|
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64635
|
| Hospital Charge Code |
30305739
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,562.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,562.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,562.96
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| 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 |
$2,232.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| 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 |
$2,603.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: Humana Medicare |
$2,277.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,232.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
DEST BY NEUR AGENT W/IMAGING
|
Facility
|
OP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
30305737
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,232.80
|
| Rate for Payer: Aetna Government |
$2,232.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,562.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,562.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,562.96
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,232.80
|
| 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 |
$2,232.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,897.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,987.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,232.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,987.19
|
| 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 |
$2,603.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,232.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,897.88
|
| Rate for Payer: Healthfirst QHP |
$2,232.80
|
| Rate for Payer: Humana Medicare |
$2,277.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,232.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,232.80
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,232.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,232.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,786.24
|
| Rate for Payer: Wellcare Medicare |
$2,121.16
|
|
|
DEST BY NEUR AGENT W/IMAGING
|
Facility
|
IP
|
$5,207.48
|
|
|
Service Code
|
HCPCS 64633
|
| Hospital Charge Code |
30305737
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$2,232.80
|
|
