|
FERRIC CARBOXYMALTOSE 750MG/15INJ
|
Facility
OP
|
$1.94
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
41646593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.15
|
| Rate for Payer: Aetna Government |
$1.15
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.15
|
| Rate for Payer: EmblemHealth Commercial |
$1.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.20
|
| Rate for Payer: Group Health Inc Commercial |
$1.15
|
| Rate for Payer: Group Health Inc Medicare |
$1.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.97
|
| Rate for Payer: Healthfirst QHP |
$1.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.16
|
| Rate for Payer: SOMOS Essential |
$1.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.92
|
| Rate for Payer: Wellcare Medicare |
$1.09
|
|
|
FERRIC CARBOXYMALTOSE 750MG/15INJ
|
Facility
IP
|
$1.94
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
41646593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
|
|
FERRIC CARBOXYMALTOSE 750MG/15INJ
|
Facility
OP
|
$1.94
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
41656593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.15
|
| Rate for Payer: Aetna Government |
$1.15
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$1.15
|
| Rate for Payer: EmblemHealth Commercial |
$1.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1.15
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.20
|
| Rate for Payer: Group Health Inc Commercial |
$1.15
|
| Rate for Payer: Group Health Inc Medicare |
$1.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.97
|
| Rate for Payer: Healthfirst QHP |
$1.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1.15
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.16
|
| Rate for Payer: SOMOS Essential |
$1.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.92
|
| Rate for Payer: Wellcare Medicare |
$1.09
|
|
|
FERRIC CARBOXYMALTOSE 750MG/15INJ
|
Facility
IP
|
$1.94
|
|
|
Service Code
|
HCPCS J1439
|
| Hospital Charge Code |
41656593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.97
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.97
|
|
|
FERRIC SUBSULFATE PASTE 8G
|
Facility
OP
|
$24.51
|
|
| Hospital Charge Code |
41654566
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$19.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.26
|
| Rate for Payer: Aetna Government |
$12.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.67
|
| Rate for Payer: Group Health Inc Commercial |
$12.26
|
| Rate for Payer: Group Health Inc Medicare |
$8.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.93
|
|
|
FERRIC SUBSULFATE PASTE 8G
|
Facility
OP
|
$24.51
|
|
| Hospital Charge Code |
41644566
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$19.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.26
|
| Rate for Payer: Aetna Government |
$12.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.67
|
| Rate for Payer: Group Health Inc Commercial |
$12.26
|
| Rate for Payer: Group Health Inc Medicare |
$8.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.93
|
|
|
FERRITIN RIA
|
Facility
OP
|
$34.08
|
|
|
Service Code
|
HCPCS 82728
|
| Hospital Charge Code |
40602375
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.90 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.63
|
| Rate for Payer: Aetna Government |
$13.63
|
| Rate for Payer: Cash Price |
$13.63
|
| Rate for Payer: Cash Price |
$13.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.63
|
| Rate for Payer: EmblemHealth Commercial |
$13.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.13
|
| Rate for Payer: Group Health Inc Commercial |
$13.63
|
| Rate for Payer: Group Health Inc Medicare |
$13.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.63
|
| Rate for Payer: Healthfirst QHP |
$13.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.90
|
| Rate for Payer: Wellcare Medicare |
$12.27
|
|
|
FERROUS GLUCONATE 300 MG TAB
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
41651190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
FERROUS GLUCONATE 300 MG TAB
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
41641190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
FERROUS SULFATE 220MG/5ML,480ML
|
Facility
OP
|
$0.01
|
|
| Hospital Charge Code |
41657031
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
FERROUS SULFATE 220MG/5ML,480ML
|
Facility
OP
|
$0.01
|
|
| Hospital Charge Code |
41647031
|
|
Hospital Revenue Code
|
250
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
FERROUS SULFATE 25 MG/ML DROPS
|
Facility
OP
|
$0.09
|
|
| Hospital Charge Code |
41651423
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
FERROUS SULFATE 25 MG/ML DROPS
|
Facility
OP
|
$0.09
|
|
| Hospital Charge Code |
41641423
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.06
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.06
|
|
|
FERROUS SULFATE 300 MG/5 ML ELIXIR UDC
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FERROUS SULFATE 300 MG/5 ML ELIXIR UDC
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FERROUS SULFATE 300MG/6.8ML UD L
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41657032
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FERROUS SULFATE 300MG/6.8ML UD L
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41647032
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
FERROUS SULFATE 325 MG TAB
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
41653759
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
FERROUS SULFATE 325 MG TAB
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
41643759
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
FETAL BLOOD KIT
|
Facility
OP
|
$38.27
|
|
| Hospital Charge Code |
40250100
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.14
|
| Rate for Payer: Aetna Government |
$19.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.02
|
| Rate for Payer: Group Health Inc Commercial |
$19.14
|
| Rate for Payer: Group Health Inc Medicare |
$13.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.14
|
|
|
FETAL CELL SCREEN
|
Facility
OP
|
$30.28
|
|
|
Service Code
|
HCPCS 86941
|
| Hospital Charge Code |
40701120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$19.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.11
|
| Rate for Payer: Aetna Government |
$12.11
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Cash Price |
$12.11
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.11
|
| Rate for Payer: EmblemHealth Commercial |
$12.11
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.78
|
| Rate for Payer: Group Health Inc Commercial |
$12.11
|
| Rate for Payer: Group Health Inc Medicare |
$12.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.11
|
| Rate for Payer: Healthfirst QHP |
$12.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.69
|
| Rate for Payer: Wellcare Medicare |
$10.90
|
|
|
FETAL CELL STAIN
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 83033
|
| Hospital Charge Code |
40701125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.00
|
| Rate for Payer: Aetna Government |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.00
|
| Rate for Payer: EmblemHealth Commercial |
$8.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.12
|
| Rate for Payer: Group Health Inc Commercial |
$8.00
|
| Rate for Payer: Group Health Inc Medicare |
$8.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.00
|
| Rate for Payer: Healthfirst QHP |
$8.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.40
|
| Rate for Payer: Wellcare Medicare |
$7.20
|
|
|
FETAL CELL STAIN.
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
HCPCS 83033
|
| Hospital Charge Code |
40621551
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.00
|
| Rate for Payer: Aetna Government |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.02
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.00
|
| Rate for Payer: EmblemHealth Commercial |
$8.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.12
|
| Rate for Payer: Group Health Inc Commercial |
$8.00
|
| Rate for Payer: Group Health Inc Medicare |
$8.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.00
|
| Rate for Payer: Healthfirst QHP |
$8.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.40
|
| Rate for Payer: Wellcare Medicare |
$7.20
|
|
|
FETAL ECHO
|
Facility
OP
|
$1,458.58
|
|
|
Service Code
|
HCPCS 76825 TC
|
| Hospital Charge Code |
30301300
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$205.75 |
| Max. Negotiated Rate |
$1,166.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$802.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$729.29
|
| Rate for Payer: Aetna Government |
$729.29
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cash Price |
$637.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$205.75
|
| Rate for Payer: Group Health Inc Commercial |
$729.29
|
| Rate for Payer: Group Health Inc Medicare |
$510.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$228.61
|
|
|
FETAL FIBRONECTIN..
|
Facility
OP
|
$161.03
|
|
|
Service Code
|
HCPCS 82731
|
| Hospital Charge Code |
40602038
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.53 |
| Max. Negotiated Rate |
$102.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$64.41
|
| Rate for Payer: Aetna Government |
$64.41
|
| Rate for Payer: Cash Price |
$64.41
|
| Rate for Payer: Cash Price |
$64.41
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$64.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$102.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$86.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$64.41
|
| Rate for Payer: EmblemHealth Commercial |
$64.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$57.97
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$54.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$57.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$64.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$57.32
|
| Rate for Payer: Group Health Inc Commercial |
$64.41
|
| Rate for Payer: Group Health Inc Medicare |
$64.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$64.41
|
| Rate for Payer: Healthfirst QHP |
$64.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$64.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$64.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$51.53
|
| Rate for Payer: Wellcare Medicare |
$57.97
|
|
