|
ALENDRONATE 5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41652235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ALENDRONATE 5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41642235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
ALENDRONATE 70 MG TAB
|
Facility
|
OP
|
$2.10
|
|
| Hospital Charge Code |
41653785
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Brighton Health Commercial |
$1.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
|
|
ALENDRONATE 70 MG TAB
|
Facility
|
OP
|
$2.10
|
|
| Hospital Charge Code |
41643785
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Brighton Health Commercial |
$1.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
|
|
ALENDRONATE SODIUM 10 MG PO TABS [15661]
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 64980034001
|
| Hospital Charge Code |
64980034001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.46
|
| Rate for Payer: Aetna Government |
$1.46
|
| Rate for Payer: Brighton Health Commercial |
$2.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.99
|
| Rate for Payer: Group Health Inc Commercial |
$1.46
|
| Rate for Payer: Group Health Inc Medicare |
$1.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.90
|
|
|
ALENDRONATE SODIUM 35 MG PO TABS [29072]
|
Facility
|
OP
|
$20.49
|
|
|
Service Code
|
NDC 69097022316
|
| Hospital Charge Code |
69097022316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.24
|
| Rate for Payer: Aetna Government |
$10.24
|
| Rate for Payer: Brighton Health Commercial |
$15.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.93
|
| Rate for Payer: Group Health Inc Commercial |
$10.24
|
| Rate for Payer: Group Health Inc Medicare |
$7.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.32
|
|
|
ALENDRONATE SODIUM 70 MG PO TABS [29048]
|
Facility
|
OP
|
$20.49
|
|
|
Service Code
|
NDC 69097022416
|
| Hospital Charge Code |
69097022416
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.24
|
| Rate for Payer: Aetna Government |
$10.24
|
| Rate for Payer: Brighton Health Commercial |
$15.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.93
|
| Rate for Payer: Group Health Inc Commercial |
$10.24
|
| Rate for Payer: Group Health Inc Medicare |
$7.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.32
|
|
|
ALENDRONATE SODIUM 70 MG PO TABS [29048]
|
Facility
|
OP
|
$20.49
|
|
|
Service Code
|
NDC 69543013120
|
| Hospital Charge Code |
69543013120
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.24
|
| Rate for Payer: Aetna Government |
$10.24
|
| Rate for Payer: Brighton Health Commercial |
$15.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.93
|
| Rate for Payer: Group Health Inc Commercial |
$10.24
|
| Rate for Payer: Group Health Inc Medicare |
$7.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.32
|
|
|
ALENDRONATE SODIUM 70 MG PO TABS [29048]
|
Facility
|
OP
|
$20.49
|
|
|
Service Code
|
NDC 65862032904
|
| Hospital Charge Code |
65862032904
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.24
|
| Rate for Payer: Aetna Government |
$10.24
|
| Rate for Payer: Brighton Health Commercial |
$15.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.39
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.93
|
| Rate for Payer: Group Health Inc Commercial |
$10.24
|
| Rate for Payer: Group Health Inc Medicare |
$7.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.32
|
|
|
ALERGN NATL INSPA BRES IMPT-SRM60
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
40005237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.25 |
| Max. Negotiated Rate |
$834.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$437.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$402.32
|
| Rate for Payer: Aetna Government |
$402.32
|
| Rate for Payer: Brighton Health Commercial |
$477.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$397.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$457.12
|
| Rate for Payer: EmblemHealth Commercial |
$397.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$834.75
|
| Rate for Payer: Group Health Inc Commercial |
$397.50
|
| Rate for Payer: Group Health Inc Medicare |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$397.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$397.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$516.75
|
|
|
ALERGN NATL INSPA BRES IMPT-SRM60
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1789
|
| Hospital Charge Code |
40005237
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$397.50 |
| Max. Negotiated Rate |
$397.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$397.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$397.50
|
|
|
ALERGN NATL INSPA RESTERL SZ-M360
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
40005238
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.00
|
| Rate for Payer: Aetna Government |
$105.00
|
| Rate for Payer: Brighton Health Commercial |
$157.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.80
|
| Rate for Payer: Group Health Inc Commercial |
$105.00
|
| Rate for Payer: Group Health Inc Medicare |
$73.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
|
|
ALGINATE DRESSING 2X2 (<=16SQIN
|
Facility
|
OP
|
$12.09
|
|
|
Service Code
|
HCPCS A6196
|
| Hospital Charge Code |
41646483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$9.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Government |
$4.47
|
| Rate for Payer: Brighton Health Commercial |
$9.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$6.04
|
| Rate for Payer: Group Health Inc Medicare |
$4.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.04
|
|
|
ALGINATE DRESSING 2X2 (<=16SQIN
|
Facility
|
OP
|
$12.09
|
|
|
Service Code
|
HCPCS A6196
|
| Hospital Charge Code |
41656483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$9.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Government |
$4.47
|
| Rate for Payer: Brighton Health Commercial |
$9.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.22
|
| Rate for Payer: Group Health Inc Commercial |
$6.04
|
| Rate for Payer: Group Health Inc Medicare |
$4.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.04
|
|
|
ALGINATE DRSG 4X5(>15<=48SQIN)
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
HCPCS A6197
|
| Hospital Charge Code |
41646485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$16.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.99
|
| Rate for Payer: Aetna Government |
$9.99
|
| Rate for Payer: Brighton Health Commercial |
$15.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.43
|
| Rate for Payer: Group Health Inc Commercial |
$10.61
|
| Rate for Payer: Group Health Inc Medicare |
$7.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.61
|
|
|
ALGINATE DRSG 4X5(>16<=48SQIN)
|
Facility
|
OP
|
$21.22
|
|
|
Service Code
|
HCPCS A6197
|
| Hospital Charge Code |
41656485
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$16.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.67
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.99
|
| Rate for Payer: Aetna Government |
$9.99
|
| Rate for Payer: Brighton Health Commercial |
$15.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.43
|
| Rate for Payer: Group Health Inc Commercial |
$10.61
|
| Rate for Payer: Group Health Inc Medicare |
$7.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.61
|
|
|
ALK PHOS ISOENZYME
|
Facility
|
IP
|
$12.95
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
40609107
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$5.18
|
|
|
ALK PHOS ISOENZYME
|
Facility
|
OP
|
$12.95
|
|
|
Service Code
|
HCPCS 84075
|
| Hospital Charge Code |
40609107
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.63 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.18
|
| Rate for Payer: Aetna Government |
$5.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.63
|
| Rate for Payer: Brighton Health Commercial |
$9.71
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Cash Price |
$5.18
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.61
|
| Rate for Payer: Group Health Inc Commercial |
$5.18
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.18
|
| Rate for Payer: Healthfirst QHP |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$6.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.14
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
|
|
ALK PHOSPHATASE, BONE SPECIFIC
|
Facility
|
OP
|
$36.95
|
|
|
Service Code
|
HCPCS 84080
|
| Hospital Charge Code |
40609866
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$27.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.78
|
| Rate for Payer: Aetna Government |
$14.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.35
|
| Rate for Payer: Brighton Health Commercial |
$27.71
|
| Rate for Payer: Cash Price |
$14.78
|
| Rate for Payer: Cash Price |
$14.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.78
|
| Rate for Payer: EmblemHealth Commercial |
$14.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.15
|
| Rate for Payer: Group Health Inc Commercial |
$14.78
|
| Rate for Payer: Group Health Inc Medicare |
$14.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.78
|
| Rate for Payer: Healthfirst QHP |
$14.78
|
| Rate for Payer: Humana Medicare |
$15.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.78
|
| Rate for Payer: United Healthcare Commercial |
$18.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.82
|
| Rate for Payer: Wellcare Medicare |
$13.30
|
|
|
ALK PHOSPHATASE, BONE SPECIFIC
|
Facility
|
IP
|
$36.95
|
|
|
Service Code
|
HCPCS 84080
|
| Hospital Charge Code |
40609866
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$14.78
|
|
|
ALLERGAN SILICONE BREAST 345CC
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS L8600
|
| Hospital Charge Code |
40004694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$326.16 |
| Max. Negotiated Rate |
$2,299.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,204.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$326.16
|
| Rate for Payer: Aetna Government |
$326.16
|
| Rate for Payer: Brighton Health Commercial |
$1,314.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,095.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,259.25
|
| Rate for Payer: EmblemHealth Commercial |
$1,095.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,299.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,095.00
|
| Rate for Payer: Group Health Inc Medicare |
$766.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,095.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,095.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,423.50
|
|
|
ALLERGAN SILICONE BREAST 345CC
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS L8600
|
| Hospital Charge Code |
40004694
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$1,095.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,095.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,095.00
|
|
|
ALLERGEN PROFILE, FOOD-BASIC
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729318
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$5.22
|
|
|
ALLERGEN PROFILE, FOOD-BASIC
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729318
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
|
ALLERGEN PROFILE, FOOD-FISH
|
Facility
|
OP
|
$13.05
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
40729319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$9.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.22
|
| Rate for Payer: Aetna Government |
$5.22
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.65
|
| Rate for Payer: Brighton Health Commercial |
$9.79
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Cash Price |
$5.22
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.22
|
| Rate for Payer: EmblemHealth Commercial |
$5.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.65
|
| Rate for Payer: Group Health Inc Commercial |
$5.22
|
| Rate for Payer: Group Health Inc Medicare |
$5.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.22
|
| Rate for Payer: Healthfirst QHP |
$5.22
|
| Rate for Payer: Humana Medicare |
$5.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare Commercial |
$6.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.18
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
|
