|
ALLODERM RTU 8 X 16 THICK
|
Facility
IP
|
$102.32
|
|
|
Service Code
|
HCPCS Q4116
|
| Hospital Charge Code |
64903241
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.16 |
| Max. Negotiated Rate |
$51.16 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.16
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
IP
|
$197,918.28
|
|
|
Service Code
|
MS-DRG 014
|
| Min. Negotiated Rate |
$77,311.16 |
| Max. Negotiated Rate |
$197,918.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$168,990.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$166,260.55
|
| Rate for Payer: Aetna Government |
$166,260.55
|
| Rate for Payer: Brighton Health Commercial |
$166,183.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$169,585.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$197,918.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163,330.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$157,947.52
|
| Rate for Payer: EmblemHealth Commercial |
$98,277.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$166,260.55
|
| Rate for Payer: Group Health Inc Commercial |
$166,260.55
|
| Rate for Payer: Group Health Inc Medicare |
$166,260.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$166,260.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$77,311.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$166,260.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166,260.55
|
| Rate for Payer: Wellcare Medicare |
$157,947.52
|
|
|
ALLOMAX 1MM GRAFT 3.9X5.9
|
Facility
IP
|
$571.20
|
|
|
Service Code
|
HCPCS Q4100
|
| Hospital Charge Code |
64903687
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.60
|
|
|
ALLOMAX 1MM GRAFT 3.9X5.9
|
Facility
OP
|
$571.20
|
|
|
Service Code
|
HCPCS Q4100
|
| Hospital Charge Code |
64903687
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$371.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$314.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.74
|
| Rate for Payer: Aetna Government |
$9.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$285.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$328.44
|
| Rate for Payer: Group Health Inc Commercial |
$285.60
|
| Rate for Payer: Group Health Inc Medicare |
$199.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$285.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$371.28
|
|
|
ALLOPURE COTTON 6MM
|
Facility
IP
|
$6,150.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,075.00 |
| Max. Negotiated Rate |
$3,075.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,075.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,075.00
|
|
|
ALLOPURE COTTON 6MM
|
Facility
OP
|
$6,150.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904445
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$6,457.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,382.50
|
| 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 |
$3,075.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,536.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,457.50
|
| Rate for Payer: Group Health Inc Commercial |
$3,075.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,152.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,075.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,075.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,997.50
|
|
|
ALLOPURE EVANS 8MM
|
Facility
OP
|
$7,487.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$7,861.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,118.12
|
| 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 |
$3,743.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,305.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,861.88
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.75
|
| Rate for Payer: Group Health Inc Medicare |
$2,620.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,743.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,866.88
|
|
|
ALLOPURE EVANS 8MM
|
Facility
IP
|
$7,487.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64904443
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,743.75 |
| Max. Negotiated Rate |
$3,743.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,743.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.75
|
|
|
ALLOPURINOL 100 MG TAB
|
Facility
OP
|
$0.11
|
|
| Hospital Charge Code |
41642666
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
ALLOPURINOL 100 MG TAB
|
Facility
OP
|
$0.11
|
|
| Hospital Charge Code |
41652666
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
ALLOPURINOL 1 MG/ML SUSP
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41642019
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
ALLOPURINOL 1 MG/ML SUSP
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41652019
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
ALLOPURINOL 300 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650757
|
|
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
|
|
|
ALLOPURINOL 300 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640757
|
|
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
|
|
|
ALL POLY BUTTON PATELLA
|
Facility
IP
|
$1,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.00 |
| Max. Negotiated Rate |
$614.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.00
|
|
|
ALL POLY BUTTON PATELLA
|
Facility
OP
|
$1,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209577
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$1,289.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$675.40
|
| 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 |
$614.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$706.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,289.40
|
| Rate for Payer: Group Health Inc Commercial |
$614.00
|
| Rate for Payer: Group Health Inc Medicare |
$429.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$798.20
|
|
|
ALL POLY BUTTON PATELLA STD #11-1
|
Facility
OP
|
$1,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$1,289.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$675.40
|
| 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 |
$614.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$706.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,289.40
|
| Rate for Payer: Group Health Inc Commercial |
$614.00
|
| Rate for Payer: Group Health Inc Medicare |
$429.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$798.20
|
|
|
ALL POLY BUTTON PATELLA STD #11-1
|
Facility
IP
|
$1,228.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40209578
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.00 |
| Max. Negotiated Rate |
$614.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.00
|
|
|
ALOGRFT ILICREST/WDGE24-26MMX31MM
|
Facility
OP
|
$181.90
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
40209425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$1,879.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,879.82
|
| Rate for Payer: Aetna Government |
$1,879.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$90.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$104.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.00
|
| Rate for Payer: Group Health Inc Commercial |
$90.95
|
| Rate for Payer: Group Health Inc Medicare |
$63.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$118.24
|
|
|
ALOGRFT ILICREST/WDGE24-26MMX31MM
|
Facility
IP
|
$181.90
|
|
|
Service Code
|
HCPCS C1762
|
| Hospital Charge Code |
40209425
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$90.95 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.95
|
|
|
ALPHA-1-ANTITRYPSIN DEFICIENCY
|
Facility
OP
|
$109.13
|
|
|
Service Code
|
HCPCS 81332
|
| Hospital Charge Code |
40609030
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.92 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$60.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.65
|
| Rate for Payer: Aetna Government |
$43.65
|
| Rate for Payer: Brighton Health Commercial |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Cash Price |
$43.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$43.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$43.65
|
| Rate for Payer: EmblemHealth Commercial |
$43.65
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$39.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$37.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$38.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$43.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38.85
|
| Rate for Payer: Group Health Inc Commercial |
$43.65
|
| Rate for Payer: Group Health Inc Medicare |
$43.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.65
|
| Rate for Payer: Healthfirst QHP |
$43.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34.92
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
|
|
ALPHA-1-ANTITRYPSIN, SERUM
|
Facility
OP
|
$33.60
|
|
|
Service Code
|
HCPCS 82103
|
| Hospital Charge Code |
40609036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$21.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.44
|
| Rate for Payer: Aetna Government |
$13.44
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.44
|
| Rate for Payer: EmblemHealth Commercial |
$13.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.96
|
| Rate for Payer: Group Health Inc Commercial |
$13.44
|
| Rate for Payer: Group Health Inc Medicare |
$13.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.44
|
| Rate for Payer: Healthfirst QHP |
$13.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.75
|
| Rate for Payer: Wellcare Medicare |
$12.10
|
|
|
ALPHA-THALASSEMIA
|
Facility
OP
|
$255.65
|
|
|
Service Code
|
HCPCS 81257
|
| Hospital Charge Code |
40629206
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$204.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$140.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102.26
|
| Rate for Payer: Aetna Government |
$102.26
|
| Rate for Payer: Brighton Health Commercial |
$102.26
|
| Rate for Payer: Cash Price |
$102.26
|
| Rate for Payer: Cash Price |
$102.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$102.26
|
| Rate for Payer: EmblemHealth Commercial |
$102.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.01
|
| Rate for Payer: Group Health Inc Commercial |
$102.26
|
| Rate for Payer: Group Health Inc Medicare |
$102.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.26
|
| Rate for Payer: Healthfirst QHP |
$102.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$81.81
|
| Rate for Payer: Wellcare Medicare |
$92.03
|
|
|
ALPHA THALASSEMIA, DNA N
|
Facility
OP
|
$255.65
|
|
|
Service Code
|
HCPCS 81257
|
| Hospital Charge Code |
30305803
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$204.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$140.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102.26
|
| Rate for Payer: Aetna Government |
$102.26
|
| Rate for Payer: Brighton Health Commercial |
$102.26
|
| Rate for Payer: Cash Price |
$102.26
|
| Rate for Payer: Cash Price |
$102.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$102.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$102.26
|
| Rate for Payer: EmblemHealth Commercial |
$102.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$92.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$86.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$91.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$102.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$91.01
|
| Rate for Payer: Group Health Inc Commercial |
$102.26
|
| Rate for Payer: Group Health Inc Medicare |
$102.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$127.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$102.26
|
| Rate for Payer: Healthfirst QHP |
$102.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$102.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$102.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$81.81
|
| Rate for Payer: Wellcare Medicare |
$92.03
|
|
|
ALPRAZOLAM 0.25 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650899
|
|
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
|
|
