|
FAM-TRASTUZUMAB DERUXTEC-NXKI 100 MG IV SOLR [170526]
|
Facility
|
IP
|
$3,242.24
|
|
|
Service Code
|
HCPCS J9358
|
| Hospital Charge Code |
65597040601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,621.12 |
| Max. Negotiated Rate |
$1,621.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,621.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,621.12
|
|
|
FAM-TRASTUZUMAB DERUXTEC-NXKI 100 MG IV SOLR [170526]
|
Facility
|
OP
|
$3,242.24
|
|
|
Service Code
|
HCPCS J9358
|
| Hospital Charge Code |
65597040601
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.79 |
| Max. Negotiated Rate |
$2,107.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,783.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.24
|
| Rate for Payer: Aetna Government |
$27.24
|
| Rate for Payer: Brighton Health Commercial |
$1,945.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,621.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,864.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$27.24
|
| Rate for Payer: EmblemHealth Commercial |
$1,621.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$27.24
|
| Rate for Payer: Group Health Inc Commercial |
$27.24
|
| Rate for Payer: Group Health Inc Medicare |
$27.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,621.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,621.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.15
|
| Rate for Payer: Healthfirst QHP |
$27.24
|
| Rate for Payer: Humana Medicare |
$27.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,107.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.79
|
|
|
FANCONI ANEMIA C
|
Facility
|
OP
|
$91.55
|
|
|
Service Code
|
HCPCS 81242
|
| Hospital Charge Code |
40603054
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.62
|
| Rate for Payer: Aetna Government |
$36.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$25.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$25.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$25.63
|
| Rate for Payer: Brighton Health Commercial |
$68.66
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$36.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$73.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$62.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$36.62
|
| Rate for Payer: EmblemHealth Commercial |
$36.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$31.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$36.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32.59
|
| Rate for Payer: Group Health Inc Commercial |
$36.62
|
| Rate for Payer: Group Health Inc Medicare |
$36.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$36.62
|
| Rate for Payer: Healthfirst QHP |
$36.62
|
| Rate for Payer: Humana Medicare |
$37.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36.62
|
| Rate for Payer: United Healthcare Commercial |
$32.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29.30
|
| Rate for Payer: Wellcare Medicare |
$32.96
|
|
|
FANCONI ANEMIA C
|
Facility
|
IP
|
$91.55
|
|
|
Service Code
|
HCPCS 81242
|
| Hospital Charge Code |
40603054
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$36.62
|
|
|
Fasciectomy, plantar fascia; partial (separate procedure)
|
Facility
|
OP
|
$3,818.01
|
|
|
Service Code
|
CPT 28060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$3,818.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
FASCIOTOMY DECOMPRESSION ANTE LEG
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 27600
|
| Hospital Charge Code |
40019885
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
FASCIOTOMY DECOMPRESSION ANTE LEG
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 27600
|
| Hospital Charge Code |
40019885
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
Fasciotomy, foot and/or toe
|
Facility
|
OP
|
$3,818.01
|
|
|
Service Code
|
CPT 28008
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$3,818.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
FASCIOTOMY PALMAR OPEN PARTIAL
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26045
|
| Hospital Charge Code |
40014144
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
FASCIOTOMY PALMAR OPEN PARTIAL
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26045
|
| Hospital Charge Code |
40014144
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
FASTENER 3.5MM/10CM ROC XS
|
Facility
|
OP
|
$965.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,013.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$531.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$579.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$482.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$555.25
|
| Rate for Payer: EmblemHealth Commercial |
$482.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,013.94
|
| Rate for Payer: Group Health Inc Commercial |
$482.83
|
| Rate for Payer: Group Health Inc Medicare |
$337.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$482.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$482.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$627.68
|
|
|
FASTENER 3.5MM/10CM ROC XS
|
Facility
|
IP
|
$965.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202287
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.83 |
| Max. Negotiated Rate |
$482.83 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$482.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$482.83
|
|
|
FASTENER,ANCHOR FAST ORAL ENDOTRA
|
Facility
|
OP
|
$21.44
|
|
| Hospital Charge Code |
64901839
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$17.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.72
|
| Rate for Payer: Aetna Government |
$10.72
|
| Rate for Payer: Brighton Health Commercial |
$16.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.58
|
| Rate for Payer: Group Health Inc Commercial |
$10.72
|
| Rate for Payer: Group Health Inc Medicare |
$7.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.72
|
|
|
FAS-TRAC 2 1/2 X 30
|
Facility
|
OP
|
$17.01
|
|
| Hospital Charge Code |
40201725
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$13.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.50
|
| Rate for Payer: Aetna Government |
$8.50
|
| Rate for Payer: Brighton Health Commercial |
$12.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.57
|
| Rate for Payer: Group Health Inc Commercial |
$8.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
|
|
FAS-TRAC 2X 24
|
Facility
|
OP
|
$12.05
|
|
| Hospital Charge Code |
40201720
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$9.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Government |
$6.02
|
| Rate for Payer: Brighton Health Commercial |
$9.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.19
|
| Rate for Payer: Group Health Inc Commercial |
$6.02
|
| Rate for Payer: Group Health Inc Medicare |
$4.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.02
|
|
|
FAS-TRAC 3 X 40
|
Facility
|
OP
|
$18.78
|
|
| Hospital Charge Code |
40201730
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.39
|
| Rate for Payer: Aetna Government |
$9.39
|
| Rate for Payer: Brighton Health Commercial |
$14.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.77
|
| Rate for Payer: Group Health Inc Commercial |
$9.39
|
| Rate for Payer: Group Health Inc Medicare |
$6.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.39
|
|
|
FAT EMULSION 20% INFUSION
|
Facility
|
OP
|
$18.42
|
|
| Hospital Charge Code |
41652474
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.21
|
| Rate for Payer: Aetna Government |
$9.21
|
| Rate for Payer: Brighton Health Commercial |
$13.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.53
|
| Rate for Payer: Group Health Inc Commercial |
$9.21
|
| Rate for Payer: Group Health Inc Medicare |
$6.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.97
|
|
|
FAT EMULSION 20% INFUSION
|
Facility
|
OP
|
$18.42
|
|
| Hospital Charge Code |
41642474
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.45 |
| Max. Negotiated Rate |
$14.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.21
|
| Rate for Payer: Aetna Government |
$9.21
|
| Rate for Payer: Brighton Health Commercial |
$13.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.53
|
| Rate for Payer: Group Health Inc Commercial |
$9.21
|
| Rate for Payer: Group Health Inc Medicare |
$6.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.97
|
|
|
FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL [180658]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 00338051909
|
| Hospital Charge Code |
00338051909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
|
|
FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL [180658]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 00338051909
|
| Hospital Charge Code |
00338051909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: EmblemHealth Commercial |
$0.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL [180659]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 00338954006
|
| Hospital Charge Code |
00338954006
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
|
|
FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL [180659]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 00338954002
|
| Hospital Charge Code |
00338954002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: EmblemHealth Commercial |
$0.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL [180659]
|
Facility
|
IP
|
$0.23
|
|
|
Service Code
|
NDC 00338954002
|
| Hospital Charge Code |
00338954002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
|
|
FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL [180659]
|
Facility
|
IP
|
$0.41
|
|
|
Service Code
|
NDC 00338954005
|
| Hospital Charge Code |
00338954005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.21 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
|
|
FAT EMULS PLANT BASE(SOY/OLIV) 20 % IV EMUL [180659]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 00338954005
|
| Hospital Charge Code |
00338954005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$0.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: EmblemHealth Commercial |
$0.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$0.43
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
