|
FETAL NON-STRESS TEST
|
Facility
OP
|
$502.93
|
|
|
Service Code
|
HCPCS 59025 TC
|
| Hospital Charge Code |
30306632
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.51 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$276.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$251.46
|
| Rate for Payer: Aetna Government |
$251.46
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| 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: Fidelis CHP/HARP/Medicaid |
$22.51
|
| 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 |
$251.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$251.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.01
|
|
|
FETAL NONSTRESS TEST-ED
|
Facility
OP
|
$792.83
|
|
|
Service Code
|
HCPCS 59025
|
| Hospital Charge Code |
30101693
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.79 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$230.44
|
| Rate for Payer: Aetna Government |
$230.44
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$230.44
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.44
|
| 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 |
$230.44
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.09
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$230.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$230.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$184.35
|
| Rate for Payer: Wellcare Medicare |
$218.92
|
|
|
FETAL SCALP BLOOD SAMPLING
|
Facility
OP
|
$819.95
|
|
|
Service Code
|
HCPCS 59030
|
| Hospital Charge Code |
40052246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$134.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$370.99
|
| Rate for Payer: Aetna Government |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Cash Price |
$370.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$370.99
|
| 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 |
$370.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$134.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$315.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$330.18
|
| Rate for Payer: Fidelis Medicare Advantage |
$370.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$330.18
|
| Rate for Payer: Group Health Inc Commercial |
$370.99
|
| Rate for Payer: Group Health Inc Medicare |
$370.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$370.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$148.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.34
|
| Rate for Payer: Healthfirst QHP |
$370.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$370.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$370.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$296.79
|
| Rate for Payer: Wellcare Medicare |
$352.44
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
IP
|
$19,961.36
|
|
|
Service Code
|
MS-DRG 864
|
| Min. Negotiated Rate |
$7,570.01 |
| Max. Negotiated Rate |
$19,961.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,016.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,569.96
|
| Rate for Payer: Aetna Government |
$19,569.96
|
| Rate for Payer: Brighton Health Commercial |
$12,800.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,961.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,245.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,580.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,591.46
|
| Rate for Payer: EmblemHealth Commercial |
$7,570.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,569.96
|
| Rate for Payer: Group Health Inc Commercial |
$19,569.96
|
| Rate for Payer: Group Health Inc Medicare |
$19,569.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,569.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,100.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,569.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,569.96
|
| Rate for Payer: Wellcare Medicare |
$18,591.46
|
|
|
FG STERLING OTW 5X150 HYB
|
Facility
IP
|
$1,087.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.74 |
| Max. Negotiated Rate |
$543.74 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$543.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$543.74
|
|
|
FG STERLING OTW 5X150 HYB
|
Facility
OP
|
$1,087.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64903765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,141.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$598.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$543.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$625.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,141.85
|
| Rate for Payer: Group Health Inc Commercial |
$543.74
|
| Rate for Payer: Group Health Inc Medicare |
$380.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$543.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$543.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$706.86
|
|
|
FIBER FLEXIVA 1000 POWER LASER
|
Facility
OP
|
$1,755.00
|
|
| Hospital Charge Code |
64904815
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$614.25 |
| Max. Negotiated Rate |
$1,404.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$965.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$877.50
|
| Rate for Payer: Aetna Government |
$877.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,404.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,193.40
|
| Rate for Payer: Group Health Inc Commercial |
$877.50
|
| Rate for Payer: Group Health Inc Medicare |
$614.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$877.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$877.50
|
|
|
FIBER FLEXIVA 200 POWER LASER
|
Facility
OP
|
$954.00
|
|
| Hospital Charge Code |
64904886
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$333.90 |
| Max. Negotiated Rate |
$763.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$524.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$477.00
|
| Rate for Payer: Aetna Government |
$477.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$763.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$648.72
|
| Rate for Payer: Group Health Inc Commercial |
$477.00
|
| Rate for Payer: Group Health Inc Medicare |
$333.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$477.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.00
|
|
|
FIBER FLEXIVA 550 POWER LASER(SU)
|
Facility
OP
|
$1,044.00
|
|
| Hospital Charge Code |
64902359
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$365.40 |
| Max. Negotiated Rate |
$835.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$574.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$522.00
|
| Rate for Payer: Aetna Government |
$522.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$835.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$709.92
|
| Rate for Payer: Group Health Inc Commercial |
$522.00
|
| Rate for Payer: Group Health Inc Medicare |
$365.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$522.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$522.00
|
|
|
FIBER LASER FLEXIVA TTIP200
|
Facility
OP
|
$1,023.44
|
|
| Hospital Charge Code |
64906748
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$358.20 |
| Max. Negotiated Rate |
$818.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$562.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$511.72
|
| Rate for Payer: Aetna Government |
$511.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$818.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$695.94
|
| Rate for Payer: Group Health Inc Commercial |
$511.72
|
| Rate for Payer: Group Health Inc Medicare |
$358.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$511.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$511.72
|
|
|
FIBER LASER FLEXVIA 1000
|
Facility
OP
|
$1,589.50
|
|
| Hospital Charge Code |
64906555
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$556.32 |
| Max. Negotiated Rate |
$1,271.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$874.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$794.75
|
| Rate for Payer: Aetna Government |
$794.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,271.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,080.86
|
| Rate for Payer: Group Health Inc Commercial |
$794.75
|
| Rate for Payer: Group Health Inc Medicare |
$556.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$794.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$794.75
|
|
|
FIBER LINK
|
Facility
OP
|
$10.42
|
|
| Hospital Charge Code |
64903084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$8.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.21
|
| Rate for Payer: Aetna Government |
$5.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.09
|
| Rate for Payer: Group Health Inc Commercial |
$5.21
|
| Rate for Payer: Group Health Inc Medicare |
$3.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.21
|
|
|
FIBERTAG
|
Facility
OP
|
$447.50
|
|
| Hospital Charge Code |
64903777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.62 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$246.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$223.75
|
| Rate for Payer: Aetna Government |
$223.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$358.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$304.30
|
| Rate for Payer: Group Health Inc Commercial |
$223.75
|
| Rate for Payer: Group Health Inc Medicare |
$156.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$223.75
|
|
|
FIBERTAK
|
Facility
OP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$1,102.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$577.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$525.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$603.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,102.50
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$367.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$525.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$682.50
|
|
|
FIBERTAK
|
Facility
IP
|
$1,050.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
64907347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$525.00
|
|
|
FIBERTAPE 17 W STR NDL
|
Facility
OP
|
$487.50
|
|
| Hospital Charge Code |
64907527
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$170.62 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$268.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$243.75
|
| Rate for Payer: Aetna Government |
$243.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$390.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$331.50
|
| Rate for Payer: Group Health Inc Commercial |
$243.75
|
| Rate for Payer: Group Health Inc Medicare |
$170.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$243.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$243.75
|
|
|
FIBERWIRE BRAIDED POLY
|
Facility
OP
|
$37.00
|
|
| Hospital Charge Code |
40200957
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$29.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.50
|
| Rate for Payer: Aetna Government |
$18.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.16
|
| Rate for Payer: Group Health Inc Commercial |
$18.50
|
| Rate for Payer: Group Health Inc Medicare |
$12.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.50
|
|
|
FIBERWIRE FIBERSTICK 2
|
Facility
OP
|
$165.00
|
|
| Hospital Charge Code |
64903001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.75 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$82.50
|
| Rate for Payer: Aetna Government |
$82.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.20
|
| Rate for Payer: Group Health Inc Commercial |
$82.50
|
| Rate for Payer: Group Health Inc Medicare |
$57.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.50
|
|
|
FIBERWIRE SUTURE KIT
|
Facility
OP
|
$1,072.00
|
|
| Hospital Charge Code |
40203111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$375.20 |
| Max. Negotiated Rate |
$857.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$589.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$536.00
|
| Rate for Payer: Aetna Government |
$536.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$857.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$728.96
|
| Rate for Payer: Group Health Inc Commercial |
$536.00
|
| Rate for Payer: Group Health Inc Medicare |
$375.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$536.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$536.00
|
|
|
FIBRINOGEN
|
Facility
OP
|
$24.30
|
|
|
Service Code
|
HCPCS 85384
|
| Hospital Charge Code |
40621500
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$13.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.72
|
| Rate for Payer: Aetna Government |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Cash Price |
$9.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.49
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.72
|
| Rate for Payer: EmblemHealth Commercial |
$9.72
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.65
|
| Rate for Payer: Group Health Inc Commercial |
$9.72
|
| Rate for Payer: Group Health Inc Medicare |
$9.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.72
|
| Rate for Payer: Healthfirst QHP |
$9.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.78
|
| Rate for Payer: Wellcare Medicare |
$8.75
|
|
|
FIDAXOMICIN 200MG TAB
|
Facility
OP
|
$10.45
|
|
| Hospital Charge Code |
41658034
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.11
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.79
|
|
|
FIDAXOMICIN 200MG TAB
|
Facility
OP
|
$10.45
|
|
| Hospital Charge Code |
41648034
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$8.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.11
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$3.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.79
|
|
|
FIELDER XT GUIDE WIRE
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66526603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$135.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.00
|
|
|
FIELDER XT GUIDE WIRE
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
66526603
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$135.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$155.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.50
|
| Rate for Payer: Group Health Inc Commercial |
$135.00
|
| Rate for Payer: Group Health Inc Medicare |
$94.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$135.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$175.50
|
|
|
FILGRASTIM 15 MCG/ML INJ PEDIATRIC
|
Facility
IP
|
$466.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41655018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$233.00 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.00
|
|
