|
DOXYCYCLINE HYCLATE 100 MG IV SOLR [2622]
|
Facility
|
IP
|
$25.27
|
|
|
Service Code
|
NDC 00143938110
|
| Hospital Charge Code |
00143938110
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$12.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.64
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV SOLR [2622]
|
Facility
|
IP
|
$30.20
|
|
|
Service Code
|
NDC 68382091010
|
| Hospital Charge Code |
68382091010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$15.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.10
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV SOLR [2622]
|
Facility
|
OP
|
$30.20
|
|
|
Service Code
|
NDC 68382091010
|
| Hospital Charge Code |
68382091010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$31.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.10
|
| Rate for Payer: Aetna Government |
$15.10
|
| Rate for Payer: Brighton Health Commercial |
$18.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.36
|
| Rate for Payer: EmblemHealth Commercial |
$15.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$31.71
|
| Rate for Payer: Group Health Inc Commercial |
$15.10
|
| Rate for Payer: Group Health Inc Medicare |
$10.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.63
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV SOLR [2622]
|
Facility
|
IP
|
$31.60
|
|
|
Service Code
|
NDC 63323013002
|
| Hospital Charge Code |
63323013002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$15.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.80
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV SOLR [2622]
|
Facility
|
IP
|
$18.20
|
|
|
Service Code
|
NDC 67457043710
|
| Hospital Charge Code |
67457043710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9.10 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.10
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV SOLR [2622]
|
Facility
|
OP
|
$18.20
|
|
|
Service Code
|
NDC 67457043710
|
| Hospital Charge Code |
67457043710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.37 |
| Max. Negotiated Rate |
$19.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.10
|
| Rate for Payer: Aetna Government |
$9.10
|
| Rate for Payer: Brighton Health Commercial |
$10.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.47
|
| Rate for Payer: EmblemHealth Commercial |
$9.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.11
|
| Rate for Payer: Group Health Inc Commercial |
$9.10
|
| Rate for Payer: Group Health Inc Medicare |
$6.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.83
|
|
|
DOXYCYCLINE HYCLATE 100 MG PO CAPS [2623]
|
Facility
|
OP
|
$9.62
|
|
|
Service Code
|
NDC 69238110002
|
| Hospital Charge Code |
69238110002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$7.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.81
|
| Rate for Payer: Aetna Government |
$4.81
|
| Rate for Payer: Brighton Health Commercial |
$7.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.54
|
| Rate for Payer: Group Health Inc Commercial |
$4.81
|
| Rate for Payer: Group Health Inc Medicare |
$3.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.25
|
|
|
DOXYCYCLINE HYCLATE 100 MG PO CAPS [2623]
|
Facility
|
OP
|
$5.53
|
|
|
Service Code
|
NDC 00143980305
|
| Hospital Charge Code |
00143980305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.77
|
| Rate for Payer: Aetna Government |
$2.77
|
| Rate for Payer: Brighton Health Commercial |
$4.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.76
|
| Rate for Payer: Group Health Inc Commercial |
$2.77
|
| Rate for Payer: Group Health Inc Medicare |
$1.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.60
|
|
|
DOXYCYCLINE HYCLATE 100 MG PO CAPS [2623]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 50268027815
|
| Hospital Charge Code |
50268027815
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.00
|
| Rate for Payer: Aetna Government |
$2.00
|
| Rate for Payer: Brighton Health Commercial |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.00
|
| Rate for Payer: Group Health Inc Medicare |
$1.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.60
|
|
|
DOXYCYCLINE HYCLATE 100 MG PO CAPS [2623]
|
Facility
|
OP
|
$3.28
|
|
|
Service Code
|
NDC 62135098550
|
| Hospital Charge Code |
62135098550
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.64
|
| Rate for Payer: Aetna Government |
$1.64
|
| Rate for Payer: Brighton Health Commercial |
$2.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.23
|
| Rate for Payer: Group Health Inc Commercial |
$1.64
|
| Rate for Payer: Group Health Inc Medicare |
$1.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.13
|
|
|
DOXYCYCLINE HYCLATE 100 MG PO CAPS [2623]
|
Facility
|
OP
|
$2.45
|
|
|
Service Code
|
NDC 00904042806
|
| Hospital Charge Code |
00904042806
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.23
|
| Rate for Payer: Aetna Government |
$1.23
|
| Rate for Payer: Brighton Health Commercial |
$1.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.67
|
| Rate for Payer: Group Health Inc Commercial |
$1.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.59
|
|
|
DR ABSC/HEMATOMA, NASAL, INT
|
Facility
|
OP
|
$620.33
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
30307891
|
|
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 |
$310.16
|
| 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
|
|
|
DR ABSC/HEMATOMA, NASAL, INT
|
Facility
|
IP
|
$620.33
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
30307891
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$282.47
|
|
|
DR ABSC/HEMATOMA, NASAL, INT
|
Facility
|
IP
|
$620.33
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
30103310
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$282.47
|
|
|
DR ABSC/HEMATOMA, NASAL, INT
|
Facility
|
OP
|
$620.33
|
|
|
Service Code
|
HCPCS 30000
|
| Hospital Charge Code |
30103310
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| 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 |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$282.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$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: EmblemHealth Commercial |
$525.00
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| 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 |
$569.00
|
| 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
|
|
|
DRAGERSORB CLICK
|
Facility
|
OP
|
$32.99
|
|
| Hospital Charge Code |
64901065
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$26.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.50
|
| Rate for Payer: Aetna Government |
$16.50
|
| Rate for Payer: Brighton Health Commercial |
$24.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.43
|
| Rate for Payer: Group Health Inc Commercial |
$16.50
|
| Rate for Payer: Group Health Inc Medicare |
$11.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.50
|
|
|
DRAIN ABSCESS OF EYELID
|
Facility
|
OP
|
$819.25
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
30105795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$336.88
|
| Rate for Payer: Aetna Government |
$336.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$235.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$235.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$235.82
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$336.88
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.88
|
| 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 |
$336.88
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.82
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$336.88
|
| Rate for Payer: Humana Medicare |
$343.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.88
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$336.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.50
|
| Rate for Payer: Wellcare Medicare |
$320.04
|
|
|
DRAIN ABSCESS OF EYELID
|
Facility
|
IP
|
$819.25
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
30105795
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$336.88
|
|
|
DRAIN ABSCESS PALATE, UVULA
|
Facility
|
IP
|
$616.78
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
30105794
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$282.47
|
|
|
DRAIN ABSCESS PALATE, UVULA
|
Facility
|
OP
|
$616.78
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
30105794
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$282.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$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: EmblemHealth Commercial |
$525.00
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| 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 |
$569.00
|
| 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
|
|
|
DRAIN ABSESS OF EYELID
|
Facility
|
IP
|
$819.25
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
30305795
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$336.88
|
|
|
DRAIN ABSESS OF EYELID
|
Facility
|
OP
|
$819.25
|
|
|
Service Code
|
HCPCS 67700
|
| Hospital Charge Code |
30305795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$336.88
|
| Rate for Payer: Aetna Government |
$336.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$235.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$235.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$235.82
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$336.88
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Cash Price |
$336.88
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$336.88
|
| 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 |
$336.88
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$286.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$299.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$336.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$299.82
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$336.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$336.88
|
| Rate for Payer: Humana Medicare |
$343.62
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$336.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$336.88
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$336.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$336.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.50
|
| Rate for Payer: Wellcare Medicare |
$320.04
|
|
|
DRAIN ABSESS PALATE, UVULA
|
Facility
|
IP
|
$616.78
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
30305794
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$282.47
|
|
|
DRAIN ABSESS PALATE, UVULA
|
Facility
|
OP
|
$616.78
|
|
|
Service Code
|
HCPCS 42000
|
| Hospital Charge Code |
30305794
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$282.47
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$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: EmblemHealth Commercial |
$525.00
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$282.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| 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 |
$569.00
|
| 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
|
|
|
DRAINAGE BAG
|
Facility
|
OP
|
$9.57
|
|
| Hospital Charge Code |
40201222
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Brighton Health Commercial |
$7.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
