|
DIDANOSINE 250 MG DR CAP
|
Facility
|
OP
|
$11.33
|
|
| Hospital Charge Code |
41653803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.66
|
| Rate for Payer: Aetna Government |
$5.66
|
| Rate for Payer: Brighton Health Commercial |
$8.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.70
|
| Rate for Payer: Group Health Inc Commercial |
$5.66
|
| Rate for Payer: Group Health Inc Medicare |
$3.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.36
|
|
|
DIDANOSINE 400 MG DR CAP
|
Facility
|
OP
|
$17.70
|
|
| Hospital Charge Code |
41642812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.85
|
| Rate for Payer: Aetna Government |
$8.85
|
| Rate for Payer: Brighton Health Commercial |
$13.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.04
|
| Rate for Payer: Group Health Inc Commercial |
$8.85
|
| Rate for Payer: Group Health Inc Medicare |
$6.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.50
|
|
|
DIDANOSINE 400 MG DR CAP
|
Facility
|
OP
|
$17.70
|
|
| Hospital Charge Code |
41652812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.85
|
| Rate for Payer: Aetna Government |
$8.85
|
| Rate for Payer: Brighton Health Commercial |
$13.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.04
|
| Rate for Payer: Group Health Inc Commercial |
$8.85
|
| Rate for Payer: Group Health Inc Medicare |
$6.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.50
|
|
|
DIFFERENTIAL-MANUAL
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
40621533
|
|
Hospital Revenue Code
|
305
|
| Rate for Payer: Cash Price |
$3.80
|
|
|
DIFFERENTIAL-MANUAL
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
HCPCS 85007
|
| Hospital Charge Code |
40621533
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$7.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.80
|
| Rate for Payer: Aetna Government |
$3.80
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.66
|
| Rate for Payer: Brighton Health Commercial |
$7.12
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.80
|
| Rate for Payer: EmblemHealth Commercial |
$3.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.80
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.38
|
| Rate for Payer: Group Health Inc Commercial |
$3.80
|
| Rate for Payer: Group Health Inc Medicare |
$3.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.80
|
| Rate for Payer: Healthfirst QHP |
$3.80
|
| Rate for Payer: Humana Medicare |
$3.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.80
|
| Rate for Payer: United Healthcare Commercial |
$4.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.04
|
| Rate for Payer: Wellcare Medicare |
$3.42
|
|
|
DIFFUSER AIR MEDTRONIC MIDAS REX
|
Facility
|
OP
|
$64.38
|
|
| Hospital Charge Code |
64904174
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.53 |
| Max. Negotiated Rate |
$51.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.19
|
| Rate for Payer: Aetna Government |
$32.19
|
| Rate for Payer: Brighton Health Commercial |
$48.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$51.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$43.78
|
| Rate for Payer: Group Health Inc Commercial |
$32.19
|
| Rate for Payer: Group Health Inc Medicare |
$22.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.19
|
|
|
DIFFUSING CAPACITY
|
Facility
|
OP
|
$173.43
|
|
|
Service Code
|
HCPCS 94729 TC
|
| Hospital Charge Code |
30305588
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$40.84 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$95.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.84
|
| Rate for Payer: Aetna Government |
$40.84
|
| Rate for Payer: Brighton Health Commercial |
$130.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$138.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$117.93
|
| Rate for Payer: Group Health Inc Commercial |
$86.72
|
| Rate for Payer: Group Health Inc Medicare |
$60.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.72
|
| Rate for Payer: United Healthcare Commercial |
$86.72
|
|
|
DIFFUSION CAPACITY TEST
|
Facility
|
OP
|
$173.43
|
|
|
Service Code
|
HCPCS 94729 TC
|
| Hospital Charge Code |
40402912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$40.84 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$95.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.84
|
| Rate for Payer: Aetna Government |
$40.84
|
| Rate for Payer: Brighton Health Commercial |
$130.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$138.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$117.93
|
| Rate for Payer: Group Health Inc Commercial |
$86.72
|
| Rate for Payer: Group Health Inc Medicare |
$60.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.72
|
| Rate for Payer: United Healthcare Commercial |
$86.72
|
|
|
DIFIBRILLATOR, C6TR01 VIVA CRT-P
|
Facility
|
OP
|
$22,868.02
|
|
|
Service Code
|
HCPCS C2621
|
| Hospital Charge Code |
40005902
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,640.47 |
| Max. Negotiated Rate |
$24,011.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,577.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,640.47
|
| Rate for Payer: Aetna Government |
$3,640.47
|
| Rate for Payer: Brighton Health Commercial |
$13,720.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,434.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,149.11
|
| Rate for Payer: EmblemHealth Commercial |
$11,434.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,011.42
|
| Rate for Payer: Group Health Inc Commercial |
$11,434.01
|
| Rate for Payer: Group Health Inc Medicare |
$8,003.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,434.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,434.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,864.21
|
|
|
DIGESTIVE MALIGNANCY WITH CC
|
Facility
|
IP
|
$32,924.55
|
|
|
Service Code
|
MSDRG 375
|
| Min. Negotiated Rate |
$10,275.40 |
| Max. Negotiated Rate |
$32,924.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,668.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,945.13
|
| Rate for Payer: Aetna Government |
$23,945.13
|
| Rate for Payer: Brighton Health Commercial |
$17,375.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,424.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,693.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,077.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,747.87
|
| Rate for Payer: EmblemHealth Commercial |
$10,275.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,945.13
|
| Rate for Payer: Group Health Inc Commercial |
$23,945.13
|
| Rate for Payer: Group Health Inc Medicare |
$23,945.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,945.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,134.49
|
| Rate for Payer: Humana Medicare |
$32,924.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,945.13
|
| Rate for Payer: United Healthcare Commercial |
$23,830.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,945.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,945.13
|
| Rate for Payer: Wellcare Medicare |
$22,747.87
|
|
|
DIGESTIVE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$50,098.77
|
|
|
Service Code
|
MSDRG 374
|
| Min. Negotiated Rate |
$16,942.49 |
| Max. Negotiated Rate |
$50,098.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30,949.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36,435.47
|
| Rate for Payer: Aetna Government |
$36,435.47
|
| Rate for Payer: Brighton Health Commercial |
$30,435.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37,164.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36,247.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29,913.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$34,613.70
|
| Rate for Payer: EmblemHealth Commercial |
$17,998.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$36,435.47
|
| Rate for Payer: Group Health Inc Commercial |
$36,435.47
|
| Rate for Payer: Group Health Inc Medicare |
$36,435.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36,435.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,942.49
|
| Rate for Payer: Humana Medicare |
$50,098.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36,435.47
|
| Rate for Payer: United Healthcare Commercial |
$41,742.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,435.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36,435.47
|
| Rate for Payer: Wellcare Medicare |
$34,613.70
|
|
|
DIGESTIVE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$27,072.68
|
|
|
Service Code
|
MSDRG 376
|
| Min. Negotiated Rate |
$7,643.76 |
| Max. Negotiated Rate |
$27,072.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,143.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,689.22
|
| Rate for Payer: Aetna Government |
$19,689.22
|
| Rate for Payer: Brighton Health Commercial |
$12,925.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,083.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,393.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,703.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,704.76
|
| Rate for Payer: EmblemHealth Commercial |
$7,643.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,689.22
|
| Rate for Payer: Group Health Inc Commercial |
$19,689.22
|
| Rate for Payer: Group Health Inc Medicare |
$19,689.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,689.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,155.49
|
| Rate for Payer: Humana Medicare |
$27,072.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,689.22
|
| Rate for Payer: United Healthcare Commercial |
$17,727.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,689.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,689.22
|
| Rate for Payer: Wellcare Medicare |
$18,704.76
|
|
|
DIGESTIVE SYS-LIPS(40490-40799)
|
Facility
|
IP
|
$616.78
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
42201725
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$282.47
|
|
|
DIGESTIVE SYS-LIPS(40490-40799)
|
Facility
|
OP
|
$616.78
|
|
|
Service Code
|
HCPCS 40490
|
| Hospital Charge Code |
42201725
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.73 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$282.47
|
| Rate for Payer: Aetna Government |
$282.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$197.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$197.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$197.73
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Cash Price |
$282.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$282.47
|
| 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 |
$282.47
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$240.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$251.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$282.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$251.40
|
| 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 |
$308.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$240.10
|
| Rate for Payer: Healthfirst QHP |
$282.47
|
| Rate for Payer: Humana Medicare |
$288.12
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$282.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$282.47
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$282.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.98
|
| Rate for Payer: Wellcare Medicare |
$268.35
|
|
|
DIGITAL COMPRES SCRW 1.8MMX30MM
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.00
|
|
|
DIGITAL COMPRES SCRW 1.8MMX30MM
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40200806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$268.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$140.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$153.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$128.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$147.20
|
| Rate for Payer: EmblemHealth Commercial |
$128.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$268.80
|
| Rate for Payer: Group Health Inc Commercial |
$128.00
|
| Rate for Payer: Group Health Inc Medicare |
$89.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$128.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$166.40
|
|
|
DIGITOXIN BLOOD
|
Facility
|
IP
|
$46.60
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
40607195
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$18.64
|
|
|
DIGITOXIN BLOOD
|
Facility
|
OP
|
$46.60
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
40607195
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$34.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.64
|
| Rate for Payer: Aetna Government |
$18.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.05
|
| Rate for Payer: Brighton Health Commercial |
$34.95
|
| Rate for Payer: Cash Price |
$18.64
|
| Rate for Payer: Cash Price |
$18.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.64
|
| Rate for Payer: EmblemHealth Commercial |
$18.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.59
|
| Rate for Payer: Group Health Inc Commercial |
$18.64
|
| Rate for Payer: Group Health Inc Medicare |
$18.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.64
|
| Rate for Payer: Healthfirst QHP |
$18.64
|
| Rate for Payer: Humana Medicare |
$19.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare Commercial |
$17.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.91
|
| Rate for Payer: Wellcare Medicare |
$16.78
|
|
|
DIGOXIN
|
Facility
|
IP
|
$33.20
|
|
|
Service Code
|
HCPCS 80162
|
| Hospital Charge Code |
40602530
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$13.28
|
|
|
DIGOXIN
|
Facility
|
OP
|
$33.20
|
|
|
Service Code
|
HCPCS 80162
|
| Hospital Charge Code |
40602530
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$24.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.28
|
| Rate for Payer: Aetna Government |
$13.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.30
|
| Rate for Payer: Brighton Health Commercial |
$24.90
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Cash Price |
$13.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.28
|
| Rate for Payer: EmblemHealth Commercial |
$13.28
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.82
|
| Rate for Payer: Group Health Inc Commercial |
$13.28
|
| Rate for Payer: Group Health Inc Medicare |
$13.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.28
|
| Rate for Payer: Healthfirst QHP |
$13.28
|
| Rate for Payer: Humana Medicare |
$13.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.28
|
| Rate for Payer: United Healthcare Commercial |
$16.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.62
|
| Rate for Payer: Wellcare Medicare |
$11.95
|
|
|
DIGOXIN 0.05 MG/ML PO SOLN [43556]
|
Facility
|
OP
|
$2.80
|
|
|
Service Code
|
NDC 00054005746
|
| Hospital Charge Code |
00054005746
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.40
|
| Rate for Payer: Aetna Government |
$1.40
|
| Rate for Payer: Brighton Health Commercial |
$2.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$1.40
|
| Rate for Payer: Group Health Inc Medicare |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.82
|
|
|
DIGOXIN 0.1 MG/ML IJ SOLN [9853]
|
Facility
|
OP
|
$165.28
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
70515026210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$132.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.42
|
| Rate for Payer: Aetna Government |
$14.42
|
| Rate for Payer: Brighton Health Commercial |
$123.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.39
|
| Rate for Payer: Group Health Inc Commercial |
$82.64
|
| Rate for Payer: Group Health Inc Medicare |
$57.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$82.64
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.43
|
|
|
DIGOXIN 0.25 MG/ML IJ SOLN [2442]
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
00781305995
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$14.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.42
|
| Rate for Payer: Aetna Government |
$14.42
|
| Rate for Payer: Brighton Health Commercial |
$2.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.54
|
| Rate for Payer: Group Health Inc Commercial |
$1.87
|
| Rate for Payer: Group Health Inc Medicare |
$1.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.43
|
|
|
DIGOXIN 0.25 MG/ML IJ SOLN [2442]
|
Facility
|
OP
|
$3.30
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
00641141035
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$14.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.42
|
| Rate for Payer: Aetna Government |
$14.42
|
| Rate for Payer: Brighton Health Commercial |
$2.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.24
|
| Rate for Payer: Group Health Inc Commercial |
$1.65
|
| Rate for Payer: Group Health Inc Medicare |
$1.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.65
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.14
|
|
|
DIGOXIN 0.25 MG/ML IJ SOLN [2442]
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
HCPCS J1160
|
| Hospital Charge Code |
00781305972
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$14.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.42
|
| Rate for Payer: Aetna Government |
$14.42
|
| Rate for Payer: Brighton Health Commercial |
$2.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.54
|
| Rate for Payer: Group Health Inc Commercial |
$1.87
|
| Rate for Payer: Group Health Inc Medicare |
$1.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.87
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$9.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$9.61
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$9.61
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$9.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.43
|
|
