|
AMIKACIN 5 MG/ ML INJ NEONATAL
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
HCPCS J0278
|
| Hospital Charge Code |
41640683
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.06
|
| Rate for Payer: Aetna Government |
$1.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.94
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$0.91
|
| Rate for Payer: SOMOS Essential |
$0.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
AMIKACIN 5 MG/ ML INJ NEONATAL
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
HCPCS J0278
|
| Hospital Charge Code |
41650683
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
|
|
AMIKACIN PEAK
|
Facility
OP
|
$37.70
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
40602585
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$23.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.08
|
| Rate for Payer: Aetna Government |
$15.08
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.08
|
| Rate for Payer: EmblemHealth Commercial |
$15.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.42
|
| Rate for Payer: Group Health Inc Commercial |
$15.08
|
| Rate for Payer: Group Health Inc Medicare |
$15.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.08
|
| Rate for Payer: Healthfirst QHP |
$15.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.06
|
| Rate for Payer: Wellcare Medicare |
$13.57
|
|
|
AMIKACIN TROUGH
|
Facility
OP
|
$37.70
|
|
|
Service Code
|
HCPCS 80150
|
| Hospital Charge Code |
40602590
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$23.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.08
|
| Rate for Payer: Aetna Government |
$15.08
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Cash Price |
$15.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.08
|
| Rate for Payer: EmblemHealth Commercial |
$15.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.42
|
| Rate for Payer: Group Health Inc Commercial |
$15.08
|
| Rate for Payer: Group Health Inc Medicare |
$15.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.08
|
| Rate for Payer: Healthfirst QHP |
$15.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.06
|
| Rate for Payer: Wellcare Medicare |
$13.57
|
|
|
AMILORIDE 5MG TAB
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41649591
|
|
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
|
|
|
AMILORIDE 5MG TAB
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
41659591
|
|
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
|
|
|
AMINO ACID 2.75%/D5W/LYTES/CA 1L
|
Facility
IP
|
$52.73
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41648564
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.36 |
| Max. Negotiated Rate |
$26.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.36
|
|
|
AMINO ACID 2.75%/D5W/LYTES/CA 1L
|
Facility
OP
|
$52.73
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41648564
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$34.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.36
|
| Rate for Payer: Aetna Government |
$26.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.32
|
| Rate for Payer: Group Health Inc Commercial |
$26.36
|
| Rate for Payer: Group Health Inc Medicare |
$18.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.27
|
|
|
AMINO ACID 2.7%/D5W/LYTES/CA 1L
|
Facility
OP
|
$52.73
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41658564
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.46 |
| Max. Negotiated Rate |
$34.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.36
|
| Rate for Payer: Aetna Government |
$26.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.32
|
| Rate for Payer: Group Health Inc Commercial |
$26.36
|
| Rate for Payer: Group Health Inc Medicare |
$18.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34.27
|
|
|
AMINO ACID 2.7%/D5W/LYTES/CA 1L
|
Facility
IP
|
$52.73
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41658564
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.36 |
| Max. Negotiated Rate |
$26.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.36
|
|
|
AMINO ACID 8%/D10W
|
Facility
IP
|
$100.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$50.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.10
|
|
|
AMINO ACID 8%/D10W
|
Facility
IP
|
$100.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$50.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.10
|
|
|
AMINO ACID 8%/D10W
|
Facility
OP
|
$100.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$65.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.10
|
| Rate for Payer: Aetna Government |
$50.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.62
|
| Rate for Payer: Group Health Inc Commercial |
$50.10
|
| Rate for Payer: Group Health Inc Medicare |
$35.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.13
|
|
|
AMINO ACID 8%/D10W
|
Facility
OP
|
$100.20
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.07 |
| Max. Negotiated Rate |
$65.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.10
|
| Rate for Payer: Aetna Government |
$50.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$50.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$57.62
|
| Rate for Payer: Group Health Inc Commercial |
$50.10
|
| Rate for Payer: Group Health Inc Medicare |
$35.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.13
|
|
|
AMINO ACID 8% + E/D10W
|
Facility
OP
|
$28.73
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$18.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.36
|
| Rate for Payer: Aetna Government |
$14.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.52
|
| Rate for Payer: Group Health Inc Commercial |
$14.36
|
| Rate for Payer: Group Health Inc Medicare |
$10.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.67
|
|
|
AMINO ACID 8% + E/D10W
|
Facility
IP
|
$28.73
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$14.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.36
|
|
|
AMINO ACID 8% + E/D10W
|
Facility
OP
|
$28.73
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$18.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.36
|
| Rate for Payer: Aetna Government |
$14.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.52
|
| Rate for Payer: Group Health Inc Commercial |
$14.36
|
| Rate for Payer: Group Health Inc Medicare |
$10.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.67
|
|
|
AMINO ACID 8% + E/D10W
|
Facility
IP
|
$28.73
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650199
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$14.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.36
|
|
|
AMINO ACID-DEXT 4.25/10 + ELE 2L
|
Facility
OP
|
$39.44
|
|
| Hospital Charge Code |
41648147
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$31.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.72
|
| Rate for Payer: Aetna Government |
$19.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.82
|
| Rate for Payer: Group Health Inc Commercial |
$19.72
|
| Rate for Payer: Group Health Inc Medicare |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.64
|
|
|
AMINO ACID-DEXT 4.25/10 +ELE 2L
|
Facility
OP
|
$39.44
|
|
| Hospital Charge Code |
41658147
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$31.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.72
|
| Rate for Payer: Aetna Government |
$19.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26.82
|
| Rate for Payer: Group Health Inc Commercial |
$19.72
|
| Rate for Payer: Group Health Inc Medicare |
$13.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.64
|
|
|
AMINO ACID-DEXT 5/15 + ELE 1L
|
Facility
OP
|
$23.82
|
|
| Hospital Charge Code |
41658149
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$19.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.91
|
| Rate for Payer: Aetna Government |
$11.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.20
|
| Rate for Payer: Group Health Inc Commercial |
$11.91
|
| Rate for Payer: Group Health Inc Medicare |
$8.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.48
|
|
|
AMINO ACID-DEXT 5/15 + ELE 1L
|
Facility
OP
|
$23.82
|
|
| Hospital Charge Code |
41648149
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$19.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.91
|
| Rate for Payer: Aetna Government |
$11.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.20
|
| Rate for Payer: Group Health Inc Commercial |
$11.91
|
| Rate for Payer: Group Health Inc Medicare |
$8.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.48
|
|
|
AMINO ACID-DEXT 5/15+ELE 2L
|
Facility
OP
|
$46.61
|
|
| Hospital Charge Code |
41658151
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$37.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.30
|
| Rate for Payer: Aetna Government |
$23.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.69
|
| Rate for Payer: Group Health Inc Commercial |
$23.30
|
| Rate for Payer: Group Health Inc Medicare |
$16.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.30
|
|
|
AMINO ACID-DEXT 5/15 + ELE 2L
|
Facility
OP
|
$46.61
|
|
| Hospital Charge Code |
41648151
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$37.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.30
|
| Rate for Payer: Aetna Government |
$23.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.69
|
| Rate for Payer: Group Health Inc Commercial |
$23.30
|
| Rate for Payer: Group Health Inc Medicare |
$16.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$30.30
|
|
|
AMINO ACID PROFILE, QN, URINE
|
Facility
OP
|
$42.18
|
|
|
Service Code
|
HCPCS 82139
|
| Hospital Charge Code |
40609874
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$26.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.87
|
| Rate for Payer: Aetna Government |
$16.87
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.87
|
| Rate for Payer: EmblemHealth Commercial |
$16.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.34
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.01
|
| Rate for Payer: Group Health Inc Commercial |
$16.87
|
| Rate for Payer: Group Health Inc Medicare |
$16.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.87
|
| Rate for Payer: Healthfirst QHP |
$16.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.50
|
| Rate for Payer: Wellcare Medicare |
$15.18
|
|
