|
FILGRASTIM 15 MCG/ML INJ PEDIATRIC
|
Facility
IP
|
$466.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41645018
|
|
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
|
|
|
FILGRASTIM 15 MCG/ML INJ PEDIATRIC
|
Facility
OP
|
$466.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41655018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$302.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$256.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$233.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$267.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.99
|
| Rate for Payer: EmblemHealth Commercial |
$0.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.84
|
| Rate for Payer: Healthfirst QHP |
$0.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.05
|
| Rate for Payer: SOMOS Essential |
$1.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$302.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: Wellcare Medicare |
$0.94
|
|
|
FILGRASTIM 15 MCG/ML INJ PEDIATRIC
|
Facility
OP
|
$466.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41645018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$302.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$256.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$233.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$267.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.99
|
| Rate for Payer: EmblemHealth Commercial |
$0.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$233.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$233.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.84
|
| Rate for Payer: Healthfirst QHP |
$0.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.05
|
| Rate for Payer: SOMOS Essential |
$1.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$302.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: Wellcare Medicare |
$0.94
|
|
|
FILGRASTIM 300 MCG/ML INJ
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41651851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.99
|
| Rate for Payer: EmblemHealth Commercial |
$0.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.84
|
| Rate for Payer: Healthfirst QHP |
$0.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.05
|
| Rate for Payer: SOMOS Essential |
$1.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: Wellcare Medicare |
$0.94
|
|
|
FILGRASTIM 300 MCG/ML INJ
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41641851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.99
|
| Rate for Payer: EmblemHealth Commercial |
$0.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.99
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.84
|
| Rate for Payer: Healthfirst QHP |
$0.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.99
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.05
|
| Rate for Payer: SOMOS Essential |
$1.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.79
|
| Rate for Payer: Wellcare Medicare |
$0.94
|
|
|
FILGRASTIM 300 MCG/ML INJ
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41651851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
|
|
FILGRASTIM 300 MCG/ML INJ
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
41641851
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
|
|
FILGRASTIM 480 MCG/1.6 ML INJ
|
Facility
OP
|
$2.41
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41643931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.39
|
| Rate for Payer: Group Health Inc Commercial |
$1.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.57
|
|
|
FILGRASTIM 480 MCG/1.6 ML INJ
|
Facility
OP
|
$2.41
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41653931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.39
|
| Rate for Payer: Group Health Inc Commercial |
$1.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.57
|
|
|
FILGRASTIM 480 MCG/1.6 ML INJ
|
Facility
IP
|
$2.41
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41643931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
|
|
FILGRASTIM 480 MCG/1.6 ML INJ
|
Facility
IP
|
$2.41
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41653931
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.20
|
|
|
FILGRASTIM-SNDZ 1MCG
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
41640389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
|
|
FILGRASTIM-SNDZ 1MCG
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
41640389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.27
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.45
|
| Rate for Payer: SOMOS Essential |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.26
|
| Rate for Payer: Wellcare Medicare |
$0.30
|
|
|
FILGRASTIM-SNDZ 1MCG
|
Facility
OP
|
$1.68
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
41650389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$0.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$0.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$0.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$0.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$0.27
|
| Rate for Payer: Healthfirst QHP |
$0.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$0.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.45
|
| Rate for Payer: SOMOS Essential |
$0.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$0.26
|
| Rate for Payer: Wellcare Medicare |
$0.30
|
|
|
FILGRASTIM-SNDZ 1MCG
|
Facility
IP
|
$1.68
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
41650389
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$0.84 |
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.84
|
|
|
FILTER, BACTERIAL
|
Facility
OP
|
$545.00
|
|
| Hospital Charge Code |
64903590
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$190.75 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$299.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.50
|
| Rate for Payer: Aetna Government |
$272.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$436.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$370.60
|
| Rate for Payer: Group Health Inc Commercial |
$272.50
|
| Rate for Payer: Group Health Inc Medicare |
$190.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$272.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$272.50
|
|
|
FILTER, CONTAINER ROUND 7 1/2
|
Facility
OP
|
$0.15
|
|
| Hospital Charge Code |
64903373
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
|
|
FILTER DCII DISP & RUB MOUTHPC
|
Facility
OP
|
$4.72
|
|
| Hospital Charge Code |
64903323
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.36
|
| Rate for Payer: Aetna Government |
$2.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.21
|
| Rate for Payer: Group Health Inc Commercial |
$2.36
|
| Rate for Payer: Group Health Inc Medicare |
$1.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.36
|
|
|
FILTER,DRAIN REPLACEMENT
|
Facility
OP
|
$237.50
|
|
| Hospital Charge Code |
64903856
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$83.12 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$118.75
|
| Rate for Payer: Aetna Government |
$118.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$190.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.50
|
| Rate for Payer: Group Health Inc Commercial |
$118.75
|
| Rate for Payer: Group Health Inc Medicare |
$83.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$118.75
|
|
|
FILTERED SPEECH TEST
|
Facility
OP
|
$101.25
|
|
|
Service Code
|
HCPCS 92571
|
| Hospital Charge Code |
42004506
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$33.61 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.38
|
| Rate for Payer: Aetna Government |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Cash Price |
$46.38
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$46.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$46.38
|
| Rate for Payer: EmblemHealth Commercial |
$46.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$33.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$39.42
|
| Rate for Payer: Fidelis Essential Plan QHP |
$41.28
|
| Rate for Payer: Fidelis Medicare Advantage |
$46.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41.28
|
| Rate for Payer: Group Health Inc Commercial |
$46.38
|
| Rate for Payer: Group Health Inc Medicare |
$46.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$37.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$39.42
|
| Rate for Payer: Healthfirst QHP |
$46.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.10
|
| Rate for Payer: Wellcare Medicare |
$44.06
|
|
|
FILTER FEMORAL CELECT SET W/NAV
|
Facility
OP
|
$2,750.00
|
|
| Hospital Charge Code |
64904888
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$962.50 |
| Max. Negotiated Rate |
$2,200.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,512.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,375.00
|
| Rate for Payer: Aetna Government |
$1,375.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,870.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,375.00
|
| Rate for Payer: Group Health Inc Medicare |
$962.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,375.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,375.00
|
|
|
FILTER HME TYCO
|
Facility
OP
|
$4.91
|
|
| Hospital Charge Code |
64901322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.34
|
| Rate for Payer: Group Health Inc Commercial |
$2.46
|
| Rate for Payer: Group Health Inc Medicare |
$1.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.46
|
|
|
FILTER LIPO TRANS FAT
|
Facility
OP
|
$190.00
|
|
| Hospital Charge Code |
64906293
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.00
|
| Rate for Payer: Aetna Government |
$95.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$152.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.20
|
| Rate for Payer: Group Health Inc Commercial |
$95.00
|
| Rate for Payer: Group Health Inc Medicare |
$66.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.00
|
|
|
FILTER MEDIA PACK 21000 TRAM
|
Facility
OP
|
$515.00
|
|
| Hospital Charge Code |
64902964
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$283.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$257.50
|
| Rate for Payer: Aetna Government |
$257.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$412.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$350.20
|
| Rate for Payer: Group Health Inc Commercial |
$257.50
|
| Rate for Payer: Group Health Inc Medicare |
$180.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.50
|
|
|
FILTER,RESPIGUARD 2,GENERAL PURP
|
Facility
OP
|
$2.23
|
|
| Hospital Charge Code |
64902203
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.12
|
| Rate for Payer: Aetna Government |
$1.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.52
|
| Rate for Payer: Group Health Inc Commercial |
$1.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.12
|
|
